Volume 26

26 Fla. L. Weekly Supp. 514b

Online Reference: FLWSUPP 2606GUERInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath -- Failure to attend -- Where insured failed to attend two scheduled EUOs, but there is no showing of unreasonableness on behalf of insured, insurer's motion for final summary judgment and motion for sanctions are denied

26 Fla. L. Weekly Supp. 44a

Online Reference: FLWSUPP 2601MIGDCivil procedure -- Expert witnesses -- Fees -- Treating physician not entitled to expert witness fees in instant case

26 Fla. L. Weekly Supp. 604a

Online Reference: FLWSUPP 2607MCKEInsurance -- Venue for breach of contract action against insurer that is domestic corporation is not proper in Volusia County where insurer has agents doing business in county but does not maintain office there, and there is no allegation that cause of action arose there -- Case is transferred to county where insurer maintains office

26 Fla. L. Weekly Supp. 304a

Online Reference: FLWSUPP 2604WINNInsurance -- Venue -- Forum selection clause -- Motion to transfer venue based on forum selection clause is granted

26 Fla. L. Weekly Supp. 301a

Online Reference: FLWSUPP 2604ROMAInsurance -- Venue -- Forum selection clause -- Where policy provision requiring any legal action against insurer to be brought in county and state where covered person lived at time of accident is valid and enforceable, and insurer did not waive its rights under clause, motion to transfer venue to county where assignor/insured resided at time of accident is granted

26 Fla. L. Weekly Supp. 298b

Online Reference: FLWSUPP 2604NOLAInsurance -- Venue -- Forum selection clause -- Policy provision requiring any legal action against insurer to be brought in county and state where covered person lived at time of accident is valid and enforceable -- Waiver -- Fact that insurer sent letter demanding dismissal of suit based on case law from court of appeal of district in which case was then pending did not waive enforcement of forum selection clause -- Insurer did not waive venue objection by actively participating in case by sending letter seeking dismissal of case, responding to discovery requests and filing discovery-related motions, or serving very limited discovery request -- Service of proposal for settlement did not waive venue objection where no acceptance of proposal was filed -- Motion to transfer venue to county in which assignor/insured resided at time of accident is granted

26 Fla. L. Weekly Supp. 500a

Online Reference: FLWSUPP 2606HUDSInsurance -- Venue -- Insurer that only participated in limited discovery and maintained objection to venue in answer and affirmative defenses and in motion to dismiss did not waive right to contest venue -- Forum selection clause that mandates that insured bring action in county where insured resides at time of accident is not ambiguous or permissive -- Assignee is bound by mandatory venue clause

26 Fla. L. Weekly Supp. 894a

Online Reference: FLWSUPP 2611RESEInsurance -- Personal injury protection -- Venue -- Forum selection clause -- Policy provision stating that any legal action against insurer must be brought in county and state where covered person lived at time of accident is valid mandatory forum selection clause -- No merit to argument that forum selection clause is invalid due to overwhelming bargaining power of insurer where plaintiff is medical provider that was not party to contract but, rather, is suing under assignment of benefits knowingly accepted from insured -- No merit to argument that insurer waived right to rely on forum selection clause by failing to supply provider with copy of policy in response to pre-suit demand

26 Fla. L. Weekly Supp. 893c

Online Reference: FLWSUPP 2611DUTKInsurance -- Venue -- Forum selection clause -- Clause mandating that suit must be filed in county and state where covered person lived at time of accident is valid floating forum selection clause -- Insurer's limited participation in discovery and filing of proposal for settlement that was not accepted did not waive enforcement of forum selection clause

26 Fla. L. Weekly Supp. 893b

Online Reference: FLWSUPP 2611ROBEInsurance -- Venue -- Forum selection clause

26 Fla. L. Weekly Supp. 839c

Online Reference: FLWSUPP 2610SPRIInsurance -- Venue -- Forum selection clause

26 Fla. L. Weekly Supp. 839b

Online Reference: FLWSUPP 2610MOONInsurance -- Venue -- Forum selection clause

26 Fla. L. Weekly Supp. 839a

Online Reference: FLWSUPP 2610MASTInsurance -- Venue -- Forum selection clause

26 Fla. L. Weekly Supp. 838a

Online Reference: FLWSUPP 2610ALLEInsurance -- Venue -- Forum selection clause

26 Fla. L. Weekly Supp. 300b

Online Reference: FLWSUPP 2604HENNInsurance -- Venue -- Where insurer is domestic corporation, and medical provider alleged that insurer maintained agents or other representatives for transaction of its customary business in Volusia County but failed to allege that insurer has or usually keeps an office for transaction of its customary business in Volusia County, provider has not alleged sufficient facts to establish that venue is proper in Volusia County under its chosen basis of venue -- Case dismissed without prejudice

26 Fla. L. Weekly Supp. 118b

Online Reference: FLWSUPP 2602MAURVenue -- Insurance -- Action against domestic corporation -- Motion to transfer venue to county in which cause of action arose granted

26 Fla. L. Weekly Supp. 556a

Online Reference: FLWSUPP 2607JJOSInsurance -- Settlement -- Payment not made within 20 days -- Where insurer issued payment under agreement for settlement of claim within twenty days of execution of release, but check contained scrivener's error in payee names, and corrected check was issued more than twenty days after execution of release, payment was not tendered within twenty-day period required by section 627.4265, and trial court erred in denying motion to enforce settlement and for interest, attorney's fees, and costs

26 Fla. L. Weekly Supp. 435b

Online Reference: FLWSUPP 2605OCONInsurance -- Settlement agreement -- Enforcement -- Sanctions are awarded to medical provider where insurer issued payment due under settlement agreement after motion to enforce agreement was filed and thirty days late

26 Fla. L. Weekly Supp. 512a

Online Reference: FLWSUPP 2606RIVEInsurance -- Failure to comply with court order -- Sanctions

26 Fla. L. Weekly Supp. 985a

Online Reference: FLWSUPP 2612JGONInsurance -- Property -- Payment of claim within 90-day safe harbor period -- No merit to insurer's argument that it is entitled to summary judgment because it paid claim within 90-day safe harbor period provided in statute and policy where insurer paid claim more than 90 days after receipt of notice of claim -- No merit to argument that 90-day period should run from date plaintiff notified insurer that it had received assignment of benefits from insured -- Where insured initially filed claim and then assigned right to plaintiff, plaintiff stands in shoes of insured as to time period for payment

26 Fla. L. Weekly Supp. 6a

Online Reference: FLWSUPP 2601SHORInsurance -- Personal injury protection -- Trial court did not err in dismissing second PIP lawsuit brought by provider/assignee against insurer -- Statute requires a claimant seeking PIP benefits to bring all claims related to same provider for same injured person to be brought in one action unless good cause is shown why claims should be brought separately

26 Fla. L. Weekly Supp. 669b

Online Reference: FLWSUPP 2608KORCInsurance -- Personal injury protection -- Standing -- Insurer waived defense of lack of standing where issue was not raised in response to demand letter or plead as affirmative defense

26 Fla. L. Weekly Supp. 760a

Online Reference: FLWSUPP 2609PICAInsurance -- Personal injury protection -- Venue -- Forum selection clause

26 Fla. L. Weekly Supp. 662a

Online Reference: FLWSUPP 2608CHAVInsurance -- Personal injury protection -- Insurance -- Personal injury protection -- Motion to strike or exclude unpled or waived issues is granted -- Bar to injection of new claim or theory subsequent to a recent Florida Supreme court ruling that undermined the original claim or theory

26 Fla. L. Weekly Supp. 433a

Online Reference: FLWSUPP 2605SOUTInsurance -- Personal injury protection -- Discovery -- Motion for rehearing of order granting insurer's motion for protective order regarding discovery related to proper application of policy deductible is denied -- Amount pled in complaint, insurer's undisputed calculation of amount at issue, and medical provider's statement that it was disputing whether statutory fee schedule was properly incorporated in policy show that complaint does not encompass claim for damages for improperly applied deductible

26 Fla. L. Weekly Supp. 119b

Online Reference: FLWSUPP 2602PERRInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- By attaching itemized statement to demand letter, medical provider satisfied requirements of section 627.736(10) -- Further, insurer waived right to raise defense of defective demand letter by failing to raised alleged deficiencies in letter before suit was filed

26 Fla. L. Weekly Supp. 663a

Online Reference: FLWSUPP 2608SAAVInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- Demand letter is not deficient for failing to account for prior payments by insurer or indicate exact amount owed

26 Fla. L. Weekly Supp. 37a

Online Reference: FLWSUPP 2601GATOInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- PIP statute does not require that demand letter account for prior payments made by insurer -- Holding litigants to high standard for demand letter specificity suggested by insurer would result in denial of access to courts

26 Fla. L. Weekly Supp. 518a

Online Reference: FLWSUPP 2606LOZAInsurance -- Personal injury protection -- Demand letter -- Validity -- No merit to insurer's contention that demand letter sent before medical provider had responded to insurer's request for additional documentation of claim was premature where request for documentation was made more than 30 days after insurer's receipt of provider's bills -- No merit to argument that bills failed to give notice of covered loss and trigger 30-day requirement to pay because they were not accompanied by supporting medical records -- Argument that demand letter was deficient for failing to account for payments made by insurer fails where insurer failed to present evidence that provider received any payments before sending letter -- Where insurer paid some of charges included in demand letter, provider was not required to send second demand letter before filing suit for those charges that were denied or reduced -- No merit to argument that demand letter was invalid for being sent to wrong insurer and naming person previously named to receive demand letters rather than currently designated person where letter was sent to insurer's umbrella company, which processes insurer's demand letters, and there is no question that letter was actually received and timely responded to be insurer

26 Fla. L. Weekly Supp. 512b

Online Reference: FLWSUPP 2606JMARInsurance -- Personal injury protection -- Demand letter that demands ten times more than medical provider could ever hope to recover is invalid

26 Fla. L. Weekly Supp. 997a

Online Reference: FLWSUPP 2612DUFFInsurance -- Personal injury protection -- Demand letter -- Medical provider failed to satisfy condition precedent to filing suit where it submitted letter demanding 80% of total charges and then sought 100% of charges after suit was filed

26 Fla. L. Weekly Supp. 330a

Online Reference: FLWSUPP 2604BOUGInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- Demand letter was not defective for demanding payment for massage services where statute that made massage services not compensable went into effect in year demand letter was submitted and its validity had not yet been upheld in court, and medical provider did not have copy of PIP policy to determine if it provided benefits for such services -- PIP statute does not mandate that demand letter state exact amount that insurer will ultimately owe

26 Fla. L. Weekly Supp. 983a

Online Reference: FLWSUPP 2612VILAInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- PIP statute does not require that demand letter account for prior payments made by insurer or attempt to state exact amount owed by insurer -- By attaching itemized statement to demand letter, medical provider satisfied statutory condition precedent of section 627.736(10)

26 Fla. L. Weekly Supp. 831a

Online Reference: FLWSUPP 2610JTHOInsurance -- Personal injury protection -- Demand letter -- Sufficiency -- By attaching itemized statement to demand letter, medical provider satisfied statutory condition precedent of section 627.736(10) -- PIP statute does not require that demand letter account for prior payments made by insurer or attempt to state exact amount owed by insurer

26 Fla. L. Weekly Supp. 121b

Online Reference: FLWSUPP 2602ROSAInsurance -- Personal injury protection -- Coverage -- Passenger in non-owned vehicle

26 Fla. L. Weekly Supp. 341b

Online Reference: FLWSUPP 2605ALVAInsurance -- Personal injury protection -- Coverage -- Owner of vehicle for which security was required by law -- Trial court erred in ruling that vehicle with salvage rebuildable title was not motor vehicle under Florida law and was, therefore, not required to be insured -- Question of whether insurance is required is dependent on whether vehicle is operated or driven on roads of state, not how vehicle is titled -- Remand for factual determination of whether vehicle was operated or driven on roads of state

26 Fla. L. Weekly Supp. 517a

Online Reference: FLWSUPP 2606SYSTInsurance -- Personal injury protection -- Motion to strike or exclude unpled or waived issues is granted -- Bar to injection of new claim or theory subsequent to a recent Florida Supreme court ruling that undermined the original claim or theory

26 Fla. L. Weekly Supp. 670a

Online Reference: FLWSUPP 2608JGONInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Unbundling -- Provider that billed for electrical stimulation therapy was not entitled to separate payment for electrical stimulation pads incident to the procedure

26 Fla. L. Weekly Supp. 772a

Online Reference: FLWSUPP 2609JACQInsurance -- Personal injury protection -- Coverage -- Medical expenses -- CPT codes -- Unbundled charges -- Where charges for range of motion testing were improperly unbundled from charge for muscle testing performed on same date, insurer properly denied payment for unbundled charges

26 Fla. L. Weekly Supp. 534a

Online Reference: FLWSUPP 2607OCEAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of benefits -- Gratuitous payments -- MRI -- Where policy expressly limited payments for MRI expenses to the applicable limitations for such expenses as prescribed by No-Fault Law, trial court properly found that payments in excess of that limit were voluntary or gratuitous -- Trial court erred in entering summary judgment in favor of provider without making specific rulings on each affirmative defense raised by insurer

26 Fla. L. Weekly Supp. 121c

Online Reference: FLWSUPP 2602MERCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Notice to insured -- PIP policy that states that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in section 627.736(5)(a)2 and will limit reimbursement to 80% of schedule of maximum charges provided adequate notice to insured that insurer could limit payment pursuant to the schedule of maximum charges -- Inclusion in policy of statement that insurer may use fact-based method to determine reasonableness of charges does not render policy language ambiguous

26 Fla. L. Weekly Supp. 35a

Online Reference: FLWSUPP 2601LGATInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- Notice to insured -- Incorporation of Office of Insurance Regulation's sample endorsement into insurer's 9810A policy was not sufficient to comply with statute requiring that policy include notice at time of issuance or renewal that insurer may limit payment pursuant to statutory schedule of charges -- Approval of policy by OIR does not constitute finding of compliance with statutory notice requirements -- Language of policy at issue incorporates an unauthorized hybrid methodology for calculating PIP reimbursement -- Provider's motion for summary judgment as to application of Medicare fee schedule granted -- Motion for summary judgment as to reasonableness, relatedness, and necessity of medical services denied

26 Fla. L. Weekly Supp. 29a

Online Reference: FLWSUPP 2601RENEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- Where definition of “reasonable charge” in PIP policy is hybrid of factors found in reasonable amount method of reimbursement and provisions from fee schedule method of reimbursement, policy is ambiguous as to reimbursement method and did not specifically elect fee schedule method of reimbursement -- Mere approval of PIP policy by Office of Insurance Regulation does not establish that policy makes proper election for payment under permissive statutory fee schedule

26 Fla. L. Weekly Supp. 466b

Online Reference: FLWSUPP 2606LOUIInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Statutory fee schedules -- Both 2013 version of statute and unambiguous Form 9810A PIP policy allow insurer to use Medicare coding policies and payment methodologies of Federal Centers for Medicare and Medicaid Services -- Insurer satisfied 2013 statutory notice requirement by having policy approved by Office of Insurance Regulation -- Policy permitted insurer to limit reimbursements utilizing 2007 Medicare Part B physician's fee schedule and Medicare's Multiple Procedure Payment Reduction

26 Fla. L. Weekly Supp. 972c

Online Reference: FLWSUPP 2612BEECInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy clearly and unambiguously elects to limit reimbursement to permissive statutory fee schedules -- Fact that policy states that insurer will not pay unreasonable benefits and will contest them does not render election of method of reimbursement ambiguous where policy defines unreasonable benefits as any charges that exceed amount to be paid under statutory fee schedules

PAMELA KENT, an Insured Individual by and through his/her Assignee, CHIROPRACTIC CENTER OF LAKELAND SOUTH, INC. d/b/a LOVE CHIROPRACTIC, Plaintiff, v. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant.

26 Fla. L. Weekly Supp. 401a

Online Reference: FLWSUPP 2605MONTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy that provides that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in PIP statute and will limit reimbursement to 80% of schedule of maximum charges clearly and unambiguously elects to limit reimbursement to statutory fee schedules

26 Fla. L. Weekly Supp. 127a

Online Reference: FLWSUPP 2602MJOSInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy that states that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in section 627.736(5)(a)2 and will limit reimbursement to 80% of schedule of maximum charges provides clear and unambiguous notice that insurer will limit reimbursement through use of permissive statutory fee schedules -- Conclusory self-serving affidavit filed by medical provider on issue of whether insurer correctly calculated reimbursement amount is stricken -- Summary judgment is entered in favor of insurer

26 Fla. L. Weekly Supp. 54a

Online Reference: FLWSUPP 2601EBANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy that tracks verbatim the language of section 627.736(5)(a) provides clear and unambiguous notice of election to limit reimbursement to permissive statutory fee schedules -- No merit to argument that policy language regarding application of deductible creates competing payment methodology where language merely expresses insurer's intent to apply deductible to fee schedule amount

26 Fla. L. Weekly Supp. 950a

Online Reference: FLWSUPP 2612ALCIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Limitation -- Statutory fee schedules -- Sufficiency of notice

26 Fla. L. Weekly Supp. 264a

Online Reference: FLWSUPP 2604ZARAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- Final summary judgment entered in favor of medical provider based on then-binding precedent regarding election of statutory fee schedules that has since been quashed by Florida Supreme Court is reversed and remanded for further proceedings consistent with supreme court decision

26 Fla. L. Weekly Supp. 88a

Online Reference: FLWSUPP 2602ADAMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Policy language provided legally sufficient notice regarding insurer's decision to use statutory reimbursement limitations

26 Fla. L. Weekly Supp. 86a

Online Reference: FLWSUPP 2602SANCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer

26 Fla. L. Weekly Supp. 10a

Online Reference: FLWSUPP 2601NIZOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules

26 Fla. L. Weekly Supp. 690a

Online Reference: FLWSUPP 2608UBIDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy provision stating that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted does not vitiate application of coinsurance provision limiting payment to 80% of reimbursable amount

26 Fla. L. Weekly Supp. 688a

Online Reference: FLWSUPP 2608BAPTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- PIP policy provision stating that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted does not vitiate application of coinsurance provision limiting payment to 80% of reimbursable amount

26 Fla. L. Weekly Supp. 587c

Online Reference: FLWSUPP 2607AMONInsurance -- Personal injury protection -- Standing -- Plaintiff does not have standing under assignment of benefits where assignment lists individual as the assignee, not the plaintiff which is a professional association bearing a title with the individual's name -- Court will not look to parol evidence to consider contrary meaning where language of assignment is unambiguous

26 Fla. L. Weekly Supp. 587b

Online Reference: FLWSUPP 2607CMONInsurance -- Personal injury protection -- Standing -- Plaintiff does not have standing under assignment of benefits where assignment lists individual as the assignee, not the plaintiff, which is a professional association bearing a title with the individual's name -- Court will not look to parol evidence to consider contrary meaning where language of assignment is unambiguous

26 Fla. L. Weekly Supp. 324a

Online Reference: FLWSUPP 2604ZELAInsurance -- Personal injury protection -- Summary judgment -- Medical provider's motion for summary judgment is granted where evidence demonstrates that insurer agreed to pay benefits, statutory penalty, and postage in settlement of claim, but insurer has submitted no proof of payment or evidence related to routine business practice to support finding that check was mailed

26 Fla. L. Weekly Supp. 143a

Online Reference: FLWSUPP 2602NUNEInsurance -- Personal injury protection -- Summary judgment is entered in favor of insurer on issue of correctness of its calculation of reductions pursuant to statutory fee schedules and Multiple Procedure Payment Reduction where insurer filed affidavit of litigation specialist and explanations of benefits detailing calculation of payments for all dates of service, and medical provider failed to file affidavit detailing contrary calculations and filed deposition in which it failed to impeach testimony of insurer's corporate representative

26 Fla. L. Weekly Supp. 125a

Online Reference: FLWSUPP 2602VELAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy that states that insurer will determine to be unreasonable any charges that exceed maximum charges set forth in PIP statute and will pay no more than 80% of schedule of maximum charges clearly and unambiguously elects to limit payment pursuant to statutory fee schedules -- Inclusion in policy of statement that insurer may use fact-based method to determine reasonableness of charges does not render policy language ambiguous -- Multiple Procedure Payment Reduction is payment methodology whose use is allowed by section 627.736(5)(a)3, not utilization limit prohibited by that statute

26 Fla. L. Weekly Supp. 521a

Online Reference: FLWSUPP 2606COACInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Multiple Procedure Payment Reduction -- Clear and unambiguous election by insurer

26 Fla. L. Weekly Supp. 146a

Online Reference: FLWSUPP 2602CANNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Multiple Procedure Payment Reduction is payment methodology whose use is allowed by section 627.736(5)(a)3, not utilization limit prohibited by that statute -- PIP policy that provides that insurer will apply MPPR when determining amount payable under Medicare fee schedule clearly and unambiguously provided notice of insurer's intent to rely upon MPPR in calculating reimbursement

26 Fla. L. Weekly Supp. 129a

Online Reference: FLWSUPP 2602TRINInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Multiple Procedure Payment Reduction is payment methodology whose use is allowed by section 627.736(5)(a)3, not utilization limit prohibited by that statute -- PIP policy that provides that insurer will apply MPPR when determining amount payable under Medicare fee schedule clearly and unambiguously provided notice of insurer's intent to rely upon MPPR in calculating reimbursement

26 Fla. L. Weekly Supp. 871a

Online Reference: FLWSUPP 2611SANCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Policy clearly and unambiguously elected use of Medicare coding policies and payment methodologies, including applicable modifiers such as Multiple Procedure Payment Reduction methodology, even without specific mention of “MPPR” -- Policy properly complied with statutory notice provision -- MPPR is permissible payment methodology, not improper utilization limit -- Trial court erred in granting summary judgment in favor of provider

26 Fla. L. Weekly Supp. 331a

Online Reference: FLWSUPP 2604ALONInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Application of Multiple Procedure Payment Reduction -- Insurer's motion for final summary judgment determining that it paid proper amount in benefits by paying 200% of Medicare fee schedule with application of MPPR is denied -- MPPR is form of utilization limit, insurer does not apply MPPR consistently and does not apply other Medicare payment modifiers that would result in higher benefit payments, and PIP statute supports medical provider's argument that insurer may be sued up to ceiling of full 200% of Medicare fee schedule

26 Fla. L. Weekly Supp. 233c

Online Reference: FLWSUPP 2603ALEXInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Relatedness and necessity of treatment -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issues of relatedness and necessity of treatment where affidavit relies on hearsay report of independent medical examination and is conclusory

26 Fla. L. Weekly Supp. 865b

Online Reference: FLWSUPP 2611ROJANOT FINAL VERSION OF OPINION
Subsequent Changes at 27 Fla. L. Weekly Supp. 349bInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Affidavit in opposition to motion for summary judgment filed by insurer was legally sufficient where it was premised upon personal knowledge and reflected admissible evidence that insurer based its payment on Medicare fee schedule -- Trial court abused its discretion in striking the affidavit and granting summary judgment in favor of provider

26 Fla. L. Weekly Supp. 521c

Online Reference: FLWSUPP 2606LANNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit and deposition filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant, whose statement that he always attempted to charge near or at 200% of Medicare fee schedule is rebutted by own charges, is not qualified to render opinion on reasonableness of charges

26 Fla. L. Weekly Supp. 521c

Online Reference: FLWSUPP 2606LANNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit and deposition filed by insurer do not preclude summary judgment in favor of medical provider on issue of reasonableness of charges where affiant, whose statement that he always attempted to charge near or at 200% of Medicare fee schedule is rebutted by own charges, is not qualified to render opinion on reasonableness of charges

26 Fla. L. Weekly Supp. 978a

Online Reference: FLWSUPP 2612WPERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Opposing affidavit filed by insurer precludes summary judgment in favor of medical provider on issue of reasonableness of charges where affidavit does not consist solely of unsupported speculation or mere subjective belief and demonstrates genuine issue of material fact on reasonableness issue -- Pure opinion testimony is permitted under Frye standard reaffirmed in Delisle

26 Fla. L. Weekly Supp. 709a

Online Reference: FLWSUPP 2609AISPInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Affidavit in opposition to summary judgment, coupled with statutory fee schedules, was sufficient to raise genuine issue of material fact on issue of reasonableness of charge

26 Fla. L. Weekly Supp. 617a

Online Reference: FLWSUPP 2608ARANInsurance -- Personal injury protection -- Medical expenses -- Reasonableness of charges -- Summary judgment was improper where parties provided competing, legally sufficient affidavits establishing a genuine issue of material fact -- Insurer's affidavit did not impermissibly rely on Medicare Part B schedule of fees -- Consideration of Medicare Part B schedule of fees is a permissible factor to be considered under section 627.736(5)(a)(1), and insurer was not seeking to limit reimbursement under 627.736(5)(a)2

26 Fla. L. Weekly Supp. 616a

Online Reference: FLWSUPP 2608LOPEInsurance -- Personal injury protection -- Medical expenses -- Reasonableness of charges -- Trial court erred in concluding that insurer's affidavit concerning reasonableness of fees was legally incompetent to create genuine issue of material fact where affiant qualified as expert, attested to his experience regarding the treatment of automobile accidents and the associated costs and reimbursements, and did not improperly rely on Medicare Part B schedule of fees

26 Fla. L. Weekly Supp. 326a

Online Reference: FLWSUPP 2604ANICInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable charges -- Summary judgment -- Insurer's corporate representative's deposition testimony that other MRI facilities in provider's zip code charge same amount as provider and that insurer has approved payment of that amount constitutes admission that provider's charges are within reasonable range and satisfies provider's prima facie burden to prove reasonableness of charges -- Affidavit of insurer's expert does not preclude summary judgment in favor of provider on reasonableness issue where affidavit is insufficient to create triable issue

26 Fla. L. Weekly Supp. 706a

Online Reference: FLWSUPP 2609TORRInsurance -- Personal injury protection -- Medical expenses -- Reasonableness of charges -- Affidavit of provider's corporate officer was not conclusory where it was based on facts personally known to the officer and properly averred that the medical charges do not exceed what is customarily charged in the community with similar providers -- Insurer was not precluded from having the opportunity to challenge medical provider's charges under section 627.736(5)(a)1 despite its failure to elect to use the fee schedule limitation under section 627.736(5)(a)2 in its policy -- Error to reject insurer's opposing expert affidavits at summary judgment stage where affiants possessed the necessary background, knowledge, and skill in their disciplines to qualify as experts

26 Fla. L. Weekly Supp. 164a

Online Reference: FLWSUPP 2603JROSInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Trial court erred in entering summary judgment in favor of medical provider on reasonableness of medical bills where there were genuine issues of material fact as to reasonableness of charges

26 Fla. L. Weekly Supp. 761a

Online Reference: FLWSUPP 2609ALEXInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment -- Medical provider set forth prima facie showing on issue of reasonableness of MRI charge where undisputed evidence shows that multiple insurance carriers, including insurer, have paid provider's charge at 80% of submitted amount -- Opposing affidavit and deposition testimony of radiologist filed by insurer does not preclude summary judgment in favor of provider -- Radiologist is not qualified as expert on reasonableness of diagnostic facility charges, his opinion is not admissible as lay opinion testimony, and he failed and refused to consider factors set forth in section 627.736(5)(a)

26 Fla. L. Weekly Supp. 909b

Online Reference: FLWSUPP 2611COMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where evidence indicates that PIP policy failed to elect to limit reimbursement to statutory fee schedules and that insurer utilized Medicare Part B fee schedule as exclusive basis for reimbursement of medical provider's claim, provider has met prima facie burden to establish that its charges are reasonable, and insurer has not filed opposing affidavit regarding reasonableness of charges, summary judgment is entered in favor of provider

26 Fla. L. Weekly Supp. 674b

Online Reference: FLWSUPP 2608YAPInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Summary judgment entered in favor of insurer

26 Fla. L. Weekly Supp. 150a

Online Reference: FLWSUPP 2602MAZOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Provider met its burden to set forth prima facie showing that its charges were reasonable through the affidavit of individual who owned the clinic and also provided care and treatment to insured -- Insurer failed to present competent, admissible evidence rebutting this prima facie showing

26 Fla. L. Weekly Supp. 134a

Online Reference: FLWSUPP 2602MAHOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Provider met its burden to set forth prima facie showing that its charges were reasonable through the affidavit of individual who owned the clinic and also provided care and treatment to insured -- Insurer failed to present competent, admissible evidence rebutting this prima facie showing

26 Fla. L. Weekly Supp. 239b

Online Reference: FLWSUPP 2603MILIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Summary judgment is granted in favor of medical provider as to relatedness and necessity of therapeutic exercises where insurer's expert found exercises to be proper part of rehabilitation process, but expert had issues with provider's record keeping that do not create disputed issue of material fact

26 Fla. L. Weekly Supp. 327a

Online Reference: FLWSUPP 2604LIBEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness, relatedness and necessity of treatment -- Summary judgment -- Opposing affidavit filed by insurer does not preclude summary judgment in favor of medical provider on issues of reasonableness of charges and relatedness and medical necessity of treatment -- Allegations in affidavit of insurer's expert concerning sufficiency of provider's medical record keeping, upcoding, and CPT coding issues do not create issues of fact where those issues were not raised as affirmative defenses -- Expert's opinion as to reasonableness of charges that is not based on anything other than his own experience and fact that Medicare and health insurance reimburse less than provider's charges fails to create genuine issue of material fact

26 Fla. L. Weekly Supp. 469a

Online Reference: FLWSUPP 2606ULLAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- X-rays and interpretation of x-rays -- Reasonableness of charges -- Necessity -- Although affidavits submitted by provider were legally sufficient to satisfy provider's summary judgment burden as to reasonableness of charges and medical necessity of treatment, affidavits submitted by insurer were legally sufficient to create genuine issue of material fact as to these issues -- Extensive discussion of experts' affidavits

26 Fla. L. Weekly Supp. 454a

Online Reference: FLWSUPP 2606JSEPInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related, and necessary treatement -- Trial court erred in entering summary judgment in favor of medical provider on issue of relatedness and medical necessity of reading and interpretation of x-rays where opposing affidavit opining that x-rays that were not read before insured underwent extensive physical therapy were not utilized to diagnose injuries or determine course of treatment created genuine issue of material fact as to whether reading and interpreting x-rays was related and necessary -- Reasonableness of charges -- Provider may submit affidavit containing his opinion about reasonableness of own bills despite offering opinion as lay witness -- Although reasonableness of charges is generally question for jury, where insurer presented no evidence in opposition to motion for summary judgment on reasonableness of charges, trial court did not err in entering summary judgment for provider on issue

26 Fla. L. Weekly Supp. 664a

Online Reference: FLWSUPP 2608DSAAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Relatedness and medical necessity of charges -- Opposing affidavit of insurer's expert is insufficient to preclude entry of summary judgment on issues of relatedness and medical necessity of charges where affidavit was not filed and served in accordance with rule 1.510(c) -- Reasonableness of charges -- Opposing affidavit on reasonableness of charges is sufficient to preclude summary judgment on that issue -- Fact that insurer did not elect statutory fee schedule method of reimbursement in policy does not mean that Medicare fee schedules are irrelevant when determining reasonableness of charges

26 Fla. L. Weekly Supp. 13a

Online Reference: FLWSUPP 2601GRACInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonableness of charges -- Trial court did not err in entering summary judgment in favor of medical provider on issue of reasonableness of charges where opposing affidavit filed by insurer, which focused on whether insurer paid reasonable amount rather than whether provider's charges were reasonable, failed to create genuine issue of material fact -- Trial court erred in entering summary judgment in favor of provider on issues of relatedness and necessity of treatment where opposing affidavit did create genuine issue of material fact as to relatedness and necessity

26 Fla. L. Weekly Supp. 33b

Online Reference: FLWSUPP 2601JSANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Related and necessary treatment -- Summary judgment -- Opposing affidavit and deposition filed by insurer do not preclude summary judgment in favor of medical provider on issues of relatedness and necessity of treatment where deposition was not filed with court and served on provider in accordance with rule 1.510(c), and affidavit is conclusory and attempts to improperly raise for first time issues of whether services were actually rendered and whether medical records were properly documented

26 Fla. L. Weekly Supp. 551a

Online Reference: FLWSUPP 2607LEWIInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Reasonable, related, and necessary treatment -- MRI -- Trial court erred in finding that insurer could not dispute relatedness and medical necessity of treatment after it had already paid claim -- Trial court erred in granting summary judgment on relatedness and necessity and on reasonableness of provider's charges where affidavit submitted by insurer raised contested issues of material fact

26 Fla. L. Weekly Supp. 705a

Online Reference: FLWSUPP 2609PAULInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Affidavit in opposition to motion for summary judgment was sufficient to create genuine issue of material fact as to reasonableness of charges and medical necessity and reasonableness of reading x-ray nine days after it was taken -- Discussion of summary judgment burden of proof

26 Fla. L. Weekly Supp. 704a

Online Reference: FLWSUPP 2609SAMBInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Relatedness and necessity of services -- Trial court erred in entering summary judgment in favor of medical provider on issues of relatedness and necessity of reading and interpreting x-rays of insured where opposing affidavit and deposition filed by insurer raised genuine issue of fact regarding relatedness and necessity of reading x-rays over one month after they were prescribed -- Reasonableness of charges -- Trial court erred in entering summary judgment in favor of provider on issue of reasonableness of charges where opposing affidavit filed by insurer raised issues of material fact

26 Fla. L. Weekly Supp. 255b

Online Reference: FLWSUPP 2604CADAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable and related treatment -- Affidavit in opposition to provider's motion for summary judgment was sufficient to create genuine issues of fact regarding reasonableness and necessity of x-ray review and interpretation -- Trial court erred in entering summary judgment in favor of provider

26 Fla. L. Weekly Supp. 51a

Online Reference: FLWSUPP 2601SILVInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related, and necessary treatment -- Provider entitled to summary judgment on issue of relatedness of treatment to accident at issue and on medical necessity and reasonableness of MRIs of left elbow and lumbar spine

26 Fla. L. Weekly Supp. 618b

Online Reference: FLWSUPP 2608SABAInsurance -- Coverage -- Medical expenses -- Reasonable, related and necessary treatment -- Summary judgment reversed where provider did not present timely, competent evidence of assignment of benefits and genuine issues of fact remain regarding whether the person mentioned in accident report is same person provider treated, whether treatments were medically necessary and related to accident, and whether the charges for such treatments was reasonable

26 Fla. L. Weekly Supp. 936a

Online Reference: FLWSUPP 2612PHILInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Reasonable, related, and necessary treatment -- MRI and reading and interpretation of MRI -- Civil procedure -- Summary judgment -- Trial court did not abuse its discretion by refusing to accept insurer's late-filed affidavit in opposition to motion for summary judgment on issue of reasonableness where insurer was not attempting to correct technical defect in a prior, timely-submitted, affidavit, but was instead attempting to submit entirely new affidavit after deciding not to rely on the earlier affidavit -- Relatedness and necessity -- Opposing affidavit was legally sufficient and created genuine issue of material fact as to relatedness and necessity of MRI, and the reading of it

26 Fla. L. Weekly Supp. 597a

Online Reference: FLWSUPP 2607BEECInsurance -- Personal injury protection -- Voluntary dismissal -- Striking -- Under rule 1.540(b), trial court has jurisdiction to consider and rule on insurer's motion to strike medical provider's notice of voluntary dismissal without prejudice -- Notice of voluntary dismissal filed after court granted provider's motion for summary judgment is void -- Because motion to strike attacks void dismissal, fact that motion was filed more than one year after filing of notice of voluntary dismissal is of no consequence -- Statutory fee schedules -- Clear and unambiguous election by insurer -- Insurer's motion for rehearing is granted based on Florida Supreme Court decision in Orthopedic Specialists -- Where provider previously represented to court that case involved pure issue of law regarding whether policy provided sufficient notice of intent to limit reimbursement to statutory fee schedules, provider is estopped from now raising other issues to avoid entry of final judgment in favor of insurer

26 Fla. L. Weekly Supp. 48b

Online Reference: FLWSUPP 2601INJUInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Policy properly incorporated ability to limit payment pursuant to section 627.736(5)(a)(1) -- Statute allows insurers to use Medicare coding policies and payment methodologies of federal Centers for Medicare and Medicaid Services, including applicable modifiers, to determine appropriate reimbursement if coding policy or payment methodology does not constitute utilization limit -- Policy provided adequate notice that defendant would be using same -- Limits for physician assistant services constitute a Medicare coding policy or payment methodology of federal Centers for Medicare and Medicaid Services

26 Fla. L. Weekly Supp. 913a

Online Reference: FLWSUPP 2611SZABInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Insurer properly based its payment for CPT 98940 on participating physician fee schedule of Medicare Part B, as mandated by policy and controlling statute

26 Fla. L. Weekly Supp. 307a

Online Reference: FLWSUPP 2604RALVInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Licensed massage therapist -- Pursuant to section 627.736(1)(a)5, licensed massage therapists are precluded from recovery of PIP benefits for all services that they perform, not just for massage therapy -- No merit to argument that section 627.736(1)(a)5 does not preclude reimbursement for services provided by licensed massage therapist where clinic that employs therapist, not therapist, is entity seeking compensation

26 Fla. L. Weekly Supp. 238b

Online Reference: FLWSUPP 2603JLUMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Licensed massage therapist services provided on behalf of a non-LMT owned and duly licensed healthcare clinic are compensable and reimbursable as PIP benefits under section 627.736(1)(a)(5)

26 Fla. L. Weekly Supp. 230a

Online Reference: FLWSUPP 2603VAZQInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Pursuant to section 486.161(1), licensed massage therapist was not required to be licensed as physical therapist or directly supervised by another licensed professional to lawfully render physical therapy that requires use of physical agents and is incidental to practice of massage therapy

26 Fla. L. Weekly Supp. 228a

Online Reference: FLWSUPP 2603GARCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Lawfully rendered services -- Pursuant to section 486.161(1), licensed massage therapist was not required to be licensed as physical therapist or directly supervised by another licensed professional to lawfully render physical therapy that required use of physical agents and was incidental to practice of massage therapy

26 Fla. L. Weekly Supp. 58a

Online Reference: FLWSUPP 2601JEANInsurance -- Personal injury protection -- Coverage -- Massage benefits -- Licensed massage therapist services provided to a non-LMT owned and duly licensed healthcare clinic and provided under CPT codes other than CPT Code 97124 and are reimburseable

26 Fla. L. Weekly Supp. 857a

Online Reference: FLWSUPP 2610BLAIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Licensed massage therapist services provided on behalf of a non-LMT owned and duly licensed healthcare clinic are compensable and reimbursable as PIP benefits under section 627.736(1)(a)(5) -- LMT may perform medical services under direction of a doctor or other medical provider and subsequently seek compensation on behalf of corporate business entity which employs LMT

26 Fla. L. Weekly Supp. 776a

Online Reference: FLWSUPP 2609MJEAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Services rendered by licensed massage therapists -- Licensed massage therapist can perform non-massage medical services under direction of doctor or other medical provider and subsequently seek compensation on behalf of the corporate business entity that employees the LMT

26 Fla. L. Weekly Supp. 774a

Online Reference: FLWSUPP 2609TERMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Services rendered by licensed massage therapists -- Licensed massage therapist can perform non-massage medical services under direction of doctor or other medical provider and subsequently seek compensation on behalf of the corporate business entity that employees the LMT

26 Fla. L. Weekly Supp. 530b

Online Reference: FLWSUPP 2606FLEUInsurance -- Personal injury protection -- Transportation costs -- Transportation cost is a reimbursable medical benefit under PIP statute only where the transportation is incurred in connection with reasonable and necessary medical treatment -- Where underlying treatment that formed basis of insured's mileage claim was not lawfully rendered, transportation in connection with the treatment is not compensable or reimbursable -- Treatment provided by provider that was not appropriately licensed under Health Care Clinic Act was not lawfully rendered -- Although clinic may have an exempt status from licensure under subsection 400.9906(4)(g) for services other than PIP services, it must be licensed under Health Care Clinic Act in order to receive reimbursement under PIP statute unless it qualifies for one of six exceptions delineated in section 627.736(5)(h)(1)-(6) -- Provider in instant case did not qualify as a clinic where it was not wholly owned by a licensed medical professional

26 Fla. L. Weekly Supp. 145b

Online Reference: FLWSUPP 2602JOSEInsurance -- Personal injury protection -- Motion to exclude/strike issues waived and/or not pled by plaintiff granted

26 Fla. L. Weekly Supp. 533a

Online Reference: FLWSUPP 2607PENKMunicipal corporations -- Code enforcement -- Due process -- Notice -- No merit to claim that city failed to give property owner proper notice of violation and hearings by sending notices to subject property that was vacant -- Notices were sent to address listed in county property appraiser's database, which was address of subject property, as required by section 162.12 -- Contrary to owner's argument, statute does not require that notices be sent return receipt requested -- Argument that city is equitably estopped from enforcing building code on property because city implied that it would not pursue enforcement was not preserved for appellate review where issue was not raised below -- Failure to check line next to option for daily fine in final order does not render order deficient where it is clear from order that fine of $150 is to run daily until compliance

26 Fla. L. Weekly Supp. 603a

Online Reference: FLWSUPP 2607DUCTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where insurer exhausted policy limits by gratuitously overpaying another medical provider for CPT code that was not reimbursable under Medicare Part B and should have been reimbursed at 80% of maximum allowance under workers' compensation fee schedule, PIP benefits are not exhausted, and plaintiff provider is entitled to additional benefits

26 Fla. L. Weekly Supp. 602a

Online Reference: FLWSUPP 2607BEHNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where insurer exhausted policy limits by gratuitously overpaying another medical provider for CPT code that was not reimbursable under Medicare Part B and should have been reimbursed at 80% of maximum allowance under workers' compensation fee schedule, PIP benefits are not exhausted, and plaintiff provider is entitled to additional benefits

26 Fla. L. Weekly Supp. 601a

Online Reference: FLWSUPP 2607PLANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where insurer exhausted policy limits by gratuitously overpaying another medical provider for CPT code that is not reimbursable under Medicare Part B and should have been reimbursed at 80% of maximum allowance under workers' compensation fee schedule, PIP benefits are not exhausted, and plaintiff provider is entitled to additional benefits

26 Fla. L. Weekly Supp. 592a

Online Reference: FLWSUPP 2607MIRAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where medical provider has shown that insurer may have exhausted policy limits by gratuitously paying for massage therapy services that were not prescribed by physician, and therefore were not lawfully rendered services, insurer's motion for summary judgment based on exhaustion of policy limits is denied

26 Fla. L. Weekly Supp. 691a

Online Reference: FLWSUPP 2608DCHAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Gratuitous payments -- Insurer's motion for summary judgment based on exhaustion of PIP benefits is denied where medical provider filed counter-evidence tending to show that insurer paid invalid claims to other providers, adjusted other claims improperly, and handled claims in bad faith -- No merit to argument that plaintiff provider does not have standing to challenge payments to other providers

26 Fla. L. Weekly Supp. 659a

Online Reference: FLWSUPP 2608CHANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Gratuitous payments -- Insurer's motion for summary judgment based on exhaustion of PIP benefits is denied where medical provider filed counter-evidence tending to show that insurer paid invalid claims to other providers, adjusted other claims improperly, and handled claims in bad faith -- No merit to argument that plaintiff provider does not have standing to challenge payments to other providers

26 Fla. L. Weekly Supp. 323a

Online Reference: FLWSUPP 2604STEEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Insurer's motion for summary judgment on issue of exhaustion of benefits is granted where insured did not plead or allege bad faith exhaustion of benefits until hearing on insurer's motion for summary judgment on exhaustion issue and did not submit any evidence of bad faith on part of insurer in adjusting hospital bill, and evidence demonstrates that insurer properly adjusted hospital bill in accordance with PIP statute

26 Fla. L. Weekly Supp. 239a

Online Reference: FLWSUPP 2603TAYLInsurance -- Personal injury protection -- Coverage -- Medical benefits -- Emergency medical condition -- $2500 limit for “bodily injury” deemed to be provided by policy at issue is subsumed into total aggregate of $10,000 available when it is determined that injured person has sustained emergency medical condition

26 Fla. L. Weekly Supp. 49a

Online Reference: FLWSUPP 2601TEAMInsurance -- Personal injury protection -- Coverage -- Emergency services -- Exhaustion of policy limits -- Where PIP insurer failed to maintain entire statutorily required reserve for emergency service providers after making partial payment to plaintiff provider within that classification, payments made to other non-emergency service providers that resulted in exhaustion of policy limits were improper, unauthorized and gratuitous

26 Fla. L. Weekly Supp. 255a

Online Reference: FLWSUPP 2604USAAInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Where insurer paid full $2,500 in benefits available to insured who had not demonstrated diagnosis of emergency medical condition and requested documentation of EMC, and insurer paid additional benefits after suit had been filed and EMC documentation was provided, trial court erred in construing post-suit payment of benefits as confession of judgment -- Insurer was not liable for benefits above $2,500 until EMC documentation was provided -- Remand for entry of summary judgment in favor of insurer

26 Fla. L. Weekly Supp. 595a

Online Reference: FLWSUPP 2607BTInsurance -- Personal injury protection -- Coverage -- Exhaustion of policy limits -- Emergency medical condition -- Where insurer properly denied medical provider's claim in excess of $2,500 in absence of determination that insured had suffered emergency medical condition and then made payment of additional PIP benefits up to $10,000 policy limit to hospital that was first provider to submit emergency medical condition determination, payment to hospital did not constitute bad faith handling of claims -- Summary judgment is entered in favor of insurer on issue of exhaustion of benefits

26 Fla. L. Weekly Supp. 400a

Online Reference: FLWSUPP 2605CRUZInsurance -- Personal injury protection -- Coverage -- Emergency medical condition -- Only licensed medical professionals listed in section 627.736(1)(a)3 are capable of making determination that insured had emergency medical condition; neither court nor insurer are authorized to make that determination -- Where medical provider failed to provide determination of emergency medical condition requested by insurer, PIP benefits were not overdue, and demand letter was premature -- Insurer did not waive requirement to provide emergency medical condition determination by paying benefits in excess of $2,500 limit for claimants who had not suffered an emergency medical condition

26 Fla. L. Weekly Supp. 1001a

Online Reference: FLWSUPP 2612CLARInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Electrodes -- PIP insurer is not required to pay separate additional charge for electrodes used in conjunction with electrical muscle stimulation treatment where electrodes are not compensable under Medicare Part B fee schedule or workers' compensation fee schedule

26 Fla. L. Weekly Supp. 994a

Online Reference: FLWSUPP 2612HENRInsurance -- Personal injury protection -- Coverage -- Medical benefits -- CPT coding -- Unbundling -- Insurer properly denied payment for electrodes where payment for electrodes was already included with calculation for payment of electrical stimulation procedure performed during the same encounter, and additional payment would have been considered unbundling and result in duplicative payment

26 Fla. L. Weekly Supp. 903a

Online Reference: FLWSUPP 2611ALANInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Electrodes -- PIP insurer is not required to pay separate additional charge for electrodes used in conjunction with electrical muscle stimulation treatment where electrodes are not compensable under Medicare Part B fee schedule or workers' compensation fee schedule -- No merit to arguments that electrodes are compensable as supply/durable medical equipment or because superior electrodes were medically necessary

26 Fla. L. Weekly Supp. 898a

Online Reference: FLWSUPP 2611ESPIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Electrodes -- PIP insurer is not required to pay separate additional charge for electrodes used in conjunction with electrical muscle stimulation treatment where electrodes are not compensable under Medicare Part B fee schedule or workers' compensation fee schedule -- No merit to arguments that electrodes are compensable as supply/durable medical equipment or because superior electrodes were medically necessary

26 Fla. L. Weekly Supp. 553a

Online Reference: FLWSUPP 2607SANTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Diagnostic testing -- Trial court erred by entering summary judgment in favor of provider who filed suit after insurer paid invoice at reduced rate set in Medicare Part B fee schedule where affidavit submitted by insurer raised genuine issue of material fact as to whether x-rays which were subject of claim were medically necessary and whether payment was reasonable

26 Fla. L. Weekly Supp. 413b

Online Reference: FLWSUPP 2605ORTIInsurance -- Personal injury protection -- Examination under oath -- Failure to attend -- Where insurer's request for EUO was made more than 30 days after it received notice of loss and medical bills, request was untimely

26 Fla. L. Weekly Supp. 613a

Online Reference: FLWSUPP 2608CHERInsurance -- Personal injury protection -- Post-loss obligations -- Examination under oath -- Failure to attend -- Timeliness of request -- Insured was not obligated to attend EUO scheduled to take place after thirty-day statutory period for payment of PIP claims had expired where insurer breached contract by failing to pay PIP claim within thirty days and failing to extend the payment period pursuant to section 627.736(4)(i)

26 Fla. L. Weekly Supp. 404b

Online Reference: FLWSUPP 2605ELOPInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath -- Failure to attend -- Where language of PIP policy, adopted from PIP statute, requires compliance with insurer's request for EUO as condition precedent to receiving PIP benefits and does not provide for any reasonable excuse for non-attendance, insured's failure to attend two properly scheduled and noticed EUOs constituted failure to satisfy condition precedent, and medical provider, as assignee of insured, is not entitled to PIP benefits

26 Fla. L. Weekly Supp. 225a

Online Reference: FLWSUPP 2603NCASInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath -- Failure to attend -- Where insurer was already in breach of policy by failing to pay PIP claim within 30 days before EUO was scheduled to take place, insured was not obligated to submit to EUO

26 Fla. L. Weekly Supp. 309b

Online Reference: FLWSUPP 2604DPERInsurance -- Personal injury protection -- Insurer properly denied payment to insured's assignee based on insured's failure to attend properly scheduled and noticed examinations under oath

26 Fla. L. Weekly Supp. 227a

Online Reference: FLWSUPP 2603LOPENOT FINAL VERSION OF OPINION
Subsequent Changes at 26 Fla. L. Weekly Supp. 404bInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath -- Failure to attend -- Where language of PIP policy, adopted from PIP statute, requires compliance with insurer's request for EUO as condition precedent to receiving PIP benefits and does not provide for any reasonable excuse for non-attendance, insured's failure to attend two properly scheduled and noticed EUOs constituted failure to satisfy condition precedent, and medical provider, as assignee of insured, is not entitled to PIP benefits

26 Fla. L. Weekly Supp. 50a

Online Reference: FLWSUPP 2601MOYNInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- No merit to argument that insurer that received bills from multiple medical providers on same day is required to look to dates of service and apply deductible to earliest date of service first -- Exhaustion of policy limits -- Insurer did not act in bad faith by making decision to use 2007 Medicare fee schedule as a baseline for reimbursement of providers -- Even if insurer had ability to reimburse other providers' claims at less than fee schedule amounts, decision to use fee schedule does not alter fact that provider exhausted benefits through payment of bills for reasonable, related and necessary services -- Further, insurer's decision to issue additional reimbursements to some providers upon receipt of pre-suit demand letters was proper and consistent with insurer's obligations under law -- Insurer's motion for summary judgment on issue of exhaustion of benefits is granted

26 Fla. L. Weekly Supp. 144a

Online Reference: FLWSUPP 2602MHERInsurance -- Personal injury protection -- Allowing plaintiff to amend complaint to raise new and different theories of recovery and to completely abandon fee schedule issues over four and a half years into litigation would unfairly prejudice defendant, who was defending case on fee schedule issue alone -- Motion to amend denied

26 Fla. L. Weekly Supp. 858a

Online Reference: FLWSUPP 2610POLAInsurance -- Personal injury protection -- Insurer's motion to amend its answer to raise new defense of defective demand letter, a condition precedent to suit, is denied -- Amendment would materially change and introduce new issues into case that involved relatively small amount of money and that had been pending for 17 months at the time motion to amend was served -- Late amendment would prejudice plaintiff given parties' stipulation that the only legal issue was whether insurer properly reimbursed plaintiff for services rendered to insured

26 Fla. L. Weekly Supp. 855a

Online Reference: FLWSUPP 2610CLARInsurance -- Personal injury protection -- Provider's motion for leave to file amended reply which would interject new and inconsistent theory of recovery over five years into litigation, sought by provider after defendant had prevailed before the Florida Supreme Court on the sole issue pled and litigated in the case, is denied -- Motion to strike or exclude unpled issues is granted

26 Fla. L. Weekly Supp. 854a

Online Reference: FLWSUPP 2610RUPIInsurance -- Personal injury protection -- Motion for leave to amend complaint, filed after Florida Supreme court decision undermined plaintiff's position on the only issue framed for disposition, is denied

26 Fla. L. Weekly Supp. 847a

Online Reference: FLWSUPP 2610LEONInsurance -- Personal injury protection -- Provider's motion for leave to file amended reply which would interject new and inconsistent theory of recovery over five years into litigation, sought by provider after defendant had prevailed before the Florida Supreme Court on the sole issue pled and litigated in the case, is denied -- Motion to strike or exclude unpled issues is granted

26 Fla. L. Weekly Supp. 844a

Online Reference: FLWSUPP 2610CHAVNOT FINAL VERSION OF OPINION
Subsequent Changes at 27 Fla. L. Weekly Supp. 976aInsurance -- Personal injury protection -- Provider's motion for leave to file amended reply which would interject new and inconsistent theory of recovery over five years into litigation, sought by provider after defendant had prevailed before the Florida Supreme Court on the sole issue pled and litigated in the case, is denied -- Motion to strike or exclude unpled issues is granted

26 Fla. L. Weekly Supp. 432a

Online Reference: FLWSUPP 2605LUGOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 430a

Online Reference: FLWSUPP 2605LASKInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy providing that charge submitted for amount less than amount allowed above shall be paid in amount of charge submitted is ambiguous as to whether “amount allowed above” is 200% of allowable amount under Medicare Part B fee schedule or 80% of that amount, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 429a

Online Reference: FLWSUPP 2605BORRInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 409a

Online Reference: FLWSUPP 2605COLEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy that states that statutory fee schedules may be used in determining how charges are paid clearly and unambiguously elects to limit reimbursement to statutory fee schedules -- Multiple Procedure Payment Reductions is payment methodology, not utilization limit prohibited by PIP statute -- Where medical provider billed charge at less than 200% of allowable amount under fee schedule, insurer properly paid 80% of amount billed

26 Fla. L. Weekly Supp. 407a

Online Reference: FLWSUPP 2605CAMPInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 311b

Online Reference: FLWSUPP 2604BRUCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy that provides that insurer will determine to be unreasonable any charges that exceed the maximum charges set forth in the PIP statute and will limit reimbursement to 80% of schedule of maximum charges provides clear and unambiguous notice of incorporation of permissive statutory fee schedule limitation into policy -- Multiple Procedure Payment Reductions is payment methodology that may be relied upon in reimbursing medical provider, not utilization limit -- Where provider charged less than 200% of allowable amount under Medicare Part B fee schedule for two CPT codes, insurer properly reimbursed for those codes at 80% of amount billed -- Outpatient Prospective Payment Systems -- No merit to provider's claim that insurer did not reimburse its bills in accordance with PIP policy because it did not apply OPPS to bills where provider failed to present any admissible evidence that OPPS would apply to it or to CPT codes billed

26 Fla. L. Weekly Supp. 908a

Online Reference: FLWSUPP 2611CHERInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Because 2% reduction applied by Centers for Medicaid and Medicare Services to physician fee schedule payment amounts for CPT codes for chiropractic manipulation is explicit part of formula for calculating fee schedule payment amounts for those CPT codes, PIP insurer is entitled to use fee schedule amounts that reflect 2% reduction when reimbursing for chiropractic services under PIP policy that adopts statutory fee schedules, and is not required to calculate reimbursement using formula that would add 2% back into fee schedule payment amounts

26 Fla. L. Weekly Supp. 901a

Online Reference: FLWSUPP 2611LINTInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Multiple Procedure Payment Reduction does not apply to chiropractic services that were not performed by physician or non-physician practitioner under written “therapy plan of care” but, rather, by unsupervised chiropractor -- Question certified

26 Fla. L. Weekly Supp. 840a

Online Reference: FLWSUPP 2610WILLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Amount paid by insurer for CPT Code 98941 on dates of service at issue for services falling under locality “99,” or “Rest of Florida,” was calculated in accordance with controlling statute and policy language

26 Fla. L. Weekly Supp. 478a

Online Reference: FLWSUPP 2606ASHFInsurance -- Personal injury protection -- Trial court erred in entering summary judgment ruling that medical provider's claim for PIP benefits is barred by class action settlement where insurer failed to show that there were no genuine issues of material fact as to whether provider was member of settlement class

26 Fla. L. Weekly Supp. 999a

Online Reference: FLWSUPP 2612KIMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 998a

Online Reference: FLWSUPP 2612RAMOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 915a

Online Reference: FLWSUPP 2611MEGAInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges

26 Fla. L. Weekly Supp. 257a

Online Reference: FLWSUPP 2604ROIGInsurance -- Personal injury protection -- Coverage -- Trial court erred in denying provider's motion for directed verdict on insurer's affirmative defense that provider submitted false or misleading statement relating to PIP claim where sole evidentiary support for insurer's defense consisted of trial testimony by insurer's corporate representative that she had “information” that there was a “possibility” of false billing by the provider

26 Fla. L. Weekly Supp. 257b

Online Reference: FLWSUPP 2604ALVAInsurance -- Personal injury protection -- Trial court abused its discretion in denying insurer's motion for leave to amend its answer to plead exhaustion of benefits as an affirmative defense where there was no indication in the record that amendment was subject to any of the exceptions for liberal pleading requirements -- Although motion for leave to amend was filed the day before hearing on plaintiff's motion for summary judgment, the case had not yet been set for trial when the motion for summary judgment was filed and, consequently, there is no prejudice

26 Fla. L. Weekly Supp. 853a

Online Reference: FLWSUPP 2610CROCInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges -- Affirmative defenses -- Amendment -- Motion to amend affirmative defenses to allege failure to strictly comply with presuit demand letter requirement is granted -- Demand letter is not defective for failing to specify exact amount insurer will ultimately owe

26 Fla. L. Weekly Supp. 852a

Online Reference: FLWSUPP 2610STAFInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Where PIP policy provides that charge submitted for amount less than 200% of allowable amount under Medicare Part B fee schedule shall be paid in amount of charge submitted, insurer was required to pay entire amount of charges that were less than 200% of allowable amount under fee schedule, not 80% of those charges -- Affirmative defenses -- Amendment -- Motion to amend affirmative defenses to allege failure to strictly comply with presuit demand letter requirement is denied -- Action for declaratory relief is not “action for benefits” to which demand letter condition precedent applies, and attempt to inject new defense at summary disposition hearing is untimely and inequitably prejudicial

26 Fla. L. Weekly Supp. 672a

Online Reference: FLWSUPP 2608STEEInsurance -- Personal injury protection -- Med pay -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Where insurer exhausted PIP and med pay benefits in payments of claims, and medical provider failed to prove bad faith on part of insurer in adjusting claims, insurer is not liable for balance of provider's reduced bill -- Insurer was not required to reserve benefits for disputed portion of provider's claim

26 Fla. L. Weekly Supp. 979b

Online Reference: FLWSUPP 2612PERIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Exhaustion of policy limits -- Insurer is precluded from asserting exhaustion of benefits defense where insurer initially denied claim on basis that claimant was not covered under daughter's PIP policy, but failed to inform medical provider for four years that claimant was covered under policy on another of its insureds and did not notify court of exhaustion of benefits under that other policy until four years after exhaustion

26 Fla. L. Weekly Supp. 995a

Online Reference: FLWSUPP 2612GUERInsurance -- Personal injury protection -- Coverage -- Examination under oath -- Failure to appear -- Insurer is not liable for PIP benefits where insured failed to appear at two EUOs of which insured and his attorney had notice, and insured offered no explanation for failure to appear

26 Fla. L. Weekly Supp. 981a

Online Reference: FLWSUPP 2612COR1Insurance -- Personal injury protection -- Coverage -- Examination under oath -- Failure to appear -- Where insured failed to comply with EUO provision of PIP policy, insurer is relieved of liability for payment of PIP benefits to medical provider -- Provider's request to abate action to allow compliance with EUO requirement is denied -- Permitting EUO two years after suit was filed would defeat purpose of EUO provision

26 Fla. L. Weekly Supp. 974a

Online Reference: FLWSUPP 2612KENNInsurance -- Personal injury protection -- Coverage -- Conditions precedent -- Examination under oath -- Failure to attend -- Where letter scheduling EUO did not mention that insurer was investigating claim for suspicion of insurance fraud, insurer was not entitled to additional 60 days to investigate claim under section 627.736(4)(i) -- Amendment to PIP statute stating that submission to EUO is condition precedent to receipt of benefits does not affect requirement that insurer comply with investigative timeline imposed by section 627.736(4)(b) -- Insurer waived right to deny benefits based on insured's failure to appear at first EUO where insurer continued to process claim thereafter and scheduled second EUO -- Insurer is precluded from denying benefits based on failure to attend second EUO where investigation had already exceeded 30-day time limit and claim was overdue by date of second EUO

26 Fla. L. Weekly Supp. 413a

Online Reference: FLWSUPP 2605HANSInsurance -- Personal injury protection -- Independent medical examination -- Physician who did not have own medical practice in years preceding IME but who performed temporary office coverage for other chiropractors for 20 days during that time was in “active practice” within meaning of statute requiring that IME physician be in active practice -- Statute requires only that physician devote professional time to evaluation, diagnosis or treatment of patients, not that physician regularly or continuously treat patients -- Motion to disqualify physician and strike IME is denied

26 Fla. L. Weekly Supp. 996a

Online Reference: FLWSUPP 2612DUYOInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Insurer that elected use of statutory fee schedule reimbursement methodology in PIP policy is entitled to use fee schedule amounts that reflect 2% reduction applied by Centers for Medicaid and Medicare Services for CPT codes for chiropractic manipulation when reimbursing for chiropractic services -- Question certified

26 Fla. L. Weekly Supp. 416a

Online Reference: FLWSUPP 2605ESTEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Because 2% reduction applied by Centers for Medicaid and Medicare Services to physician fee schedule payment amounts for CPT codes for chiropractic manipulation is explicit part of formula for calculating fee schedule payment amounts for those CPT codes, PIP insurer is entitled to use fee schedule amounts that reflect 2% reduction when reimbursing for chiropractic services under PIP policy that adopts statutory fee schedules and is not required to calculate reimbursement using formula that would add 2% back into fee schedule payment amounts

26 Fla. L. Weekly Supp. 1003a

Online Reference: FLWSUPP 2612SAGMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- CPT coding -- Claim for re-examination conducted on same date of service as chiropractic manipulation was not payable where medical provider failed to include modifier required by CPT coding guidelines

26 Fla. L. Weekly Supp. 1004a

Online Reference: FLWSUPP 2612GRIMInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Material misrepresentation regarding claim -- Where claimant who was passenger in covered vehicle at time of accident made material misrepresentation to insurer regarding his residence on date of loss, insurer is not required to pay claim

26 Fla. L. Weekly Supp. 298a

Online Reference: FLWSUPP 2604WARNInsurance -- Personal injury protection -- Med pay -- Standing -- Injured insured has standing to bring action against insurer for PIP and med pay benefits for full amount of services billed by medical provider and denied by insurer, irrespective of whether insured has paid bills

26 Fla. L. Weekly Supp. 38a

Online Reference: FLWSUPP 2601AMInsurance -- Personal injury protection -- Venue -- Forum selection clause -- Provision requiring any legal action against insurer to be brought in county and state where covered person lived at time of accident, unless insurer agreed otherwise, was mandatory and enforceable absent showing that it is unreasonable or unjust -- Motion to transfer venue to county in which assignor/insured resided at time of accident granted

26 Fla. L. Weekly Supp. 521b

Online Reference: FLWSUPP 2606CARAInsurance -- Personal injury protection -- Defendant's rule 1.140 motion for judgment on pleadings was not proper in small claims proceeding where rules of civil procedure were not invoked and it had been made clear that case would proceed under small claims rules -- Plaintiff's motion for relief from judgment is granted -- Judgment on pleadings pursuant to small claims rule not proper due to posture of the case

26 Fla. L. Weekly Supp. 620a

Online Reference: FLWSUPP 2608WHITInsurance -- Small claims -- Confession of judgment -- No error in entering judgment after insurer filed confession of judgment -- Responsive pleading to a complaint is not required under small claims rules, and there was no issue of fact left to resolve

26 Fla. L. Weekly Supp. 968a

Online Reference: FLWSUPP 2612BISCInsurance -- Homeowners -- Standing -- Assignment clearly and unambiguously transfers insured's rights under policy to plaintiff -- Assignment of benefits on homestead property is ineffective where assignment was not fully executed in manner prescribed by sections 689.01 and 689.111

26 Fla. L. Weekly Supp. 17a

Online Reference: FLWSUPP 2601SIDEInsurance -- Property -- Sinkhole damage -- Civil procedure -- Bifurcation -- Motion to bifurcate trial into two parts addressing issues of whether structural damage existed and whether damage was caused by sinkhole activity excluded from coverage denied -- Many of same witnesses will testify as to both issues, and insurer has failed to show that it will be prejudiced by trying issues together or that bifurcation would serve interests of judicial economy

26 Fla. L. Weekly Supp. 97a

Online Reference: FLWSUPP 2602ZABAInsurance -- Homeowners -- Final summary judgment is entered in favor of insurer on claim for supplemental hurricane damage where insured failed to comply with post-loss obligations to provide notice of loss and keep repair records -- Insured's initial notice of loss did not satisfy post-loss obligation to give immediate notice of alleged additional damage to property -- Insurer was prejudiced by failure to give notice of alleged supplemental damage where insured claims to have repaired damage without maintaining any photographs of damage or record of repairs before giving notice to insurer, thereby depriving insurer of any ability to investigate claim

26 Fla. L. Weekly Supp. 93a

Online Reference: FLWSUPP 2602BEEBInsurance -- Homeowners -- Coverage -- Conditions precedent -- Insurer not entitled to summary judgment based on its affirmative defenses that plaintiff failed to comply with conditions precedent to suit, including filing of sworn proof of loss and immediate notice of loss, where genuine issue of material fact exists as to whether material breach occurred and whether insurer, that denied coverage on basis that residence did not sustain functional hail damage, was prejudiced

26 Fla. L. Weekly Supp. 45c

Online Reference: FLWSUPP 2601WATSInsurance -- Homeowners -- Coverage -- Conditions precedent -- Failure to comply -- Dismissal required where insured failed to submit sworn proof of loss and failed to submit to requested examination under oath

26 Fla. L. Weekly Supp. 558b

Online Reference: FLWSUPP 2607DIXOInsurance -- Homeowners -- Dismissal -- Fraud on court -- Trial court's dismissal of complaint for fraud on court is affirmed where plaintiff offered no evidence that technician was at insured's home on days that humidity log indicated readings were taken, certificate of completion and satisfaction appeared to have been altered, and insurer presented credible evidence that not all services billed were actually performed -- Trial court was not required to hold evidentiary hearing on motion to dismiss for fraud on court

26 Fla. L. Weekly Supp. 914a

Online Reference: FLWSUPP 2611COLLInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Declaratory action brought by claimant injured while passenger in vehicle owned by her boyfriend seeking declaration as to whether she is owed coverage under boyfriend's PIP policy or under policy covering vehicle that claimant co-owns with her father with whom she does not reside and on which she is not named insured -- Fact that claimant is co-owner of insured vehicle for which she is not included as named insured does not exclude her from coverage as passenger in boyfriend's vehicle -- Insurer of vehicle co-owned by claimant and father is not required to extend coverage to claimant

26 Fla. L. Weekly Supp. 887a

Online Reference: FLWSUPP 2611PITTInsurance -- Personal injury protection -- Exclusions -- Claimant who was not listed under policy and who was owner of motor vehicle in Florida for which security was required under No-Fault Law was specifically excluded from PIP coverage under policy at issue

26 Fla. L. Weekly Supp. 242a

Online Reference: FLWSUPP 2603WADDInsurance -- Personal injury protection -- Coverage -- Vehicle owned by insured but not covered under PIP policy -- Where claimant was injured while driving vehicle of which he was beneficial owner but not title owner, and claimant had not notified his PIP insurer of beneficial ownership of accident vehicle or added accident vehicle as insured vehicle under his policy, insurer does not owe PIP coverage for loss

26 Fla. L. Weekly Supp. 2a

Online Reference: FLWSUPP 2601AFFOInsurance -- Homeowners -- Coverage -- Exclusions -- Mold -- Trial court erred in granting motion to dismiss by ruling on an ultimate fact in dispute regarding whether claim for mold testing services performed following water intrusion fell within policy's mold exclusion -- Remand for further proceedings

26 Fla. L. Weekly Supp. 139b

Online Reference: FLWSUPP 2602FERDInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Statutory fee schedules -- Clear and unambiguous election by insurer -- PIP policy that states that insurer will determine to be unreasonable any charges that exceed schedule of maximum charges provided pursuant to section 627.736(5)(a)2 and will limit reimbursement to 80% of schedule of maximum charges clearly and unambiguously elects to limit payment pursuant to permissive statutory fee schedules -- Inclusion in policy of statement that insurer will pay 80% of all reasonable expenses does not render policy language ambiguous -- Physician fee schedule published by federal Department of Health and Human Services on CMS website is not hearsay -- Insurer properly reimbursed medical provider in compliance with Medicare fee schedule and is entitled to summary judgment

26 Fla. L. Weekly Supp. 766a

Online Reference: FLWSUPP 2609VILLInsurance -- Personal injury protection -- Summary judgment -- Evidence -- Hearsay -- Exception -- Business records -- Transcript of examination under oath prepared for purpose of litigation lacks trustworthiness that business records are presumed to have and is not admissible under business records exception to hearsay rule -- Further, transcript is not admissible as former testimony where EUO was taken without opportunity for cross-examination or objection, was not deposition, and was not obtained in course of judicial proceeding, and transcript was not reviewed and signed by insured -- Pursuant to section 92.33, EUO transcript cannot be used as summary judgment evidence where copy was not provided to insured at time he submitted to EUO -- Transcript is not admissible under party admission exception to hearsay rule where insured is not party to case, and plaintiff medical provider and insured have different interests in action -- Motion to strike transcript is granted

26 Fla. L. Weekly Supp. 105a

Online Reference: FLWSUPP 2602PETZInsurance -- Liability -- Duty to defend -- General contractor not entitled to summary judgment on its third-party complaint against subcontractor's liability insurer, claiming that contractor was an additional insured under policy and that insurer had duty to defend it in action brought against contractor and subcontractor/named insured by bicyclist who was injured when he struck manhole cover near construction site that was substantially ajar and protruding above surface of roadway -- Policy, as plainly written, provided coverage to unnamed “Additional Insureds” confronted with claim based upon the negligent acts or omissions of the named insured, and plaintiff sued contractor for, and only for, its own alleged negligence

26 Fla. L. Weekly Supp. 896b

Online Reference: FLWSUPP 2611RRAMInsurance -- Voluntary dismissal -- Timeliness of notice -- Notice of voluntary dismissal filed ten calendar days after hearing on insurer's motion for final summary judgment is untimely -- Motion to strike is granted

26 Fla. L. Weekly Supp. 121a

Online Reference: FLWSUPP 2602METZInsurance -- Dismissal of provider's action against insurer with leave to amend

26 Fla. L. Weekly Supp. 303a

Online Reference: FLWSUPP 2604CLAIInsurance -- Discovery -- Documents -- Insurer is not entitled to discovery of trade secret documents not reasonably calculated to lead to discoverable and relevant evidence

26 Fla. L. Weekly Supp. 508a

Online Reference: FLWSUPP 2606LESLInsurance -- Personal injury protection -- Discovery -- Reasonableness of charges -- Usual and customary charges satisfy the “reasonable expense” mandate of PIP statute -- Insurer not entitled to additional discovery on issue of reasonableness where insurer limited its payment to 75% of billed amounts and in its explanation of benefits informed provider that allowable amount was calculated pursuant to statute limiting reimbursement to 75% of provider's usual and customary charges for emergency services

26 Fla. L. Weekly Supp. 509a

Online Reference: FLWSUPP 2606FRANInsurance -- Personal injury protection -- Discovery -- Reasonableness of charges -- Geozip or community pricing report -- Insurer is compelled to produce documentation indicating what other medical providers within geographic region charged for CPT codes at issue during specific time frame

26 Fla. L. Weekly Supp. 685a

Online Reference: FLWSUPP 2608MOLIInsurance -- Personal injury protection -- Discovery -- Medical provider is ordered to provide better answers to interrogatories, requests to produce, and requests for admissions regarding insured's medical condition, treatment provided, and insured's status as employee of provider at time of treatment

26 Fla. L. Weekly Supp. 133b

Online Reference: FLWSUPP 2602WIGGInsurance -- Personal injury protection -- Discovery -- Provider need not provide documents or information regarding payments received from secondary payers such as Medicaid, Medicare and private insurance

26 Fla. L. Weekly Supp. 874a

Online Reference: FLWSUPP 2611RUIZInsurance -- Personal injury protection -- Discovery -- Trial court departed from essential requirements of law by requiring medical provider to disclose nonparty medical bills, insurance claim forms, and reimbursement information without requiring statutorily mandated notification to affected nonparties

26 Fla. L. Weekly Supp. 912a

Online Reference: FLWSUPP 2611CLAIInsurance -- Discovery -- Trade secrets -- Where purchase agreement and addendum sought in discovery do not contain any information regarding claim at issue, do not discuss scope of work or pricing, and have no effect on issue of coverage and amount of benefits owed, documents are not relevant for purposes of discovery -- Furthermore, documents meet criteria for assertion of trade secret privilege, and insurer has not shown reasonable necessity for them

26 Fla. L. Weekly Supp. 984a

Online Reference: FLWSUPP 2612DEUSInsurance -- Personal injury protection -- Discovery -- Objections to discovery regarding method employed by insurer to determine reimbursement levels in community, reasonableness of charges and amount to reimburse medical provider and insurer's position that insured's injuries are not related to accident are overruled

26 Fla. L. Weekly Supp. 985b

Online Reference: FLWSUPP 2612CARMInsurance -- Personal injury protection -- Answer -- Timeliness -- Filing answer and affirmative defenses one day after court's deadline does not warrant sanctions -- Discovery -- Failure to comply -- Where insurer failed to comply with discovery rules and six discovery orders, monetary sanctions are appropriate

26 Fla. L. Weekly Supp. 325a

Online Reference: FLWSUPP 2604DEMEInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has repeatedly failed to comply with discovery obligations and has disobeyed multiple court orders, insurer's pleadings are stricken and final judgment is entered in favor of medical provider

26 Fla. L. Weekly Supp. 320b

Online Reference: FLWSUPP 2604CORIInsurance -- Discovery -- Failure to comply -- Sanctions -- Insurer's filing of notice of dismissal without prejudice did not divest trial court of jurisdiction to enforce order compelling response to discovery that was entered prior to dismissal or to rule on motion for sanctions that was filed prior to dismissal -- No merit to argument that no further sanction could be imposed because dismissal itself was ultimate sanction where dismissal was without prejudice -- Monetary sanction imposed

26 Fla. L. Weekly Supp. 311a

Online Reference: FLWSUPP 2604MGUEInsurance -- Discovery -- Failure to comply -- Sanctions -- Where insurer responded to discovery more than 200 days after deadline imposed in agreed order, any and all objections to discovery other than privilege have been waived -- Insurer is ordered to serve amended discovery response without asserting objections other than privilege -- Monetary sanctions imposed

26 Fla. L. Weekly Supp. 309a

Online Reference: FLWSUPP 2604LGUEInsurance -- Discovery -- Failure to comply -- Sanctions -- Where insurer responded to discovery more than 200 days after deadline imposed in agreed order, any and all objections to discovery other than privilege have been waived -- Insurer is ordered to serve amended discovery response without asserting objections other than privilege -- Monetary sanctions imposed

26 Fla. L. Weekly Supp. 131a

Online Reference: FLWSUPP 2602DELAInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where insurer has willfully disregarded twelve court orders, insurer's staff has been repeatedly sanctioned for violations of orders by various courts, insurer is directly responsible for violations due to its failure to hire sufficient staff, medical provider was prejudiced by delay in production of medical records until first day of trial, there was no adequate justification for noncompliance, and court's administration of justice has been hampered by noncompliance, motion to strike pleadings is granted and default is entered in favor of provider

26 Fla. L. Weekly Supp. 30b

Online Reference: FLWSUPP 2601GANDInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Where medical provider seeking reimbursement for non-prescription drug did not comply with multiple court orders compelling it to respond to discovery and provide drug cost invoice to insurer, sanctions are imposed, and insurer's motion for summary judgment is granted

26 Fla. L. Weekly Supp. 46a

Online Reference: FLWSUPP 2601JWALInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Insurer's failure to respond to requests for discovery, respond to motions to compel discovery, provide deposition dates after cancellation of deposition of its corporate representative and comply with order setting status conference requiring that counsel be fully versed on status of case results in striking of insurer's pleadings and entry of judgment in favor of medical provider where insurer's lack of cooperation was willful and contumacious, insurer was involved in failure to cooperate, lack of cooperation has prejudiced provider and created significant problems of judicial administration, and insurer's inaction in case evinces willful and deliberate decision to abandon case

26 Fla. L. Weekly Supp. 21a

Online Reference: FLWSUPP 2601FRAZInsurance -- Property -- Discovery -- Failure to comply -- Sanctions -- Monetary sanction equal to amount claimed by insureds in damages for alleged water loss is imposed on insureds' counsel and his law firm jointly and severally and case is dismissed with prejudice as sanction for misconduct where insureds did not provide notice of loss until forty days after alleged loss; allegedly failed parts were discarded, thousands of dollars of repairs were allegedly performed before loss was reported, and no photographs or videotapes were taken of loss; insureds did not provide sworn proof of loss; neither insureds, their counsel nor their public adjuster appeared for scheduled examinations under oath; insureds did not respond to discovery for over five months and then provided response that was grossly deficient, mendacious and unverified; and insureds failed to participate in first scheduled depositions, and their counsel engaged in obstructionist conduct throughout second depositions ordered by court

26 Fla. L. Weekly Supp. 897a

Online Reference: FLWSUPP 2611GRAJInsurance -- Discovery -- Claim file -- Insurer is required to bring to depositions claim file listed on notices, but privileged documents need not be disclosed

26 Fla. L. Weekly Supp. 848a

Online Reference: FLWSUPP 2610HERNInsurance -- Personal injury protection -- Discovery -- Examination under oath -- EUO transcripts are discoverable as business records utilized by insurer in claims handling process

26 Fla. L. Weekly Supp. 32a

Online Reference: FLWSUPP 2601IDIAInsurance -- Personal injury protection -- Discovery -- Name and address of pre-litigation adjuster formerly employed by insurer

26 Fla. L. Weekly Supp. 897b

Online Reference: FLWSUPP 2611GUILInsurance -- Personal injury protection -- Discovery -- Depositions -- Motion to compel deposition of corporate representative of claims management company who made determination that more documentation was needed for insured's PIP claim is denied where discovery insured seeks is not relevant to issue of whether insurer's explanation of reimbursement informing insured that additional documentation was needed to make reimbursement decision constituted request for documentation under section 627.736(6)(b) -- Even if court found that EOR contained 6(b) request for documentation, requested deposition would not be relevant as testimony of employee of company is not binding on insurer

26 Fla. L. Weekly Supp. 847c

Online Reference: FLWSUPP 2610BASUInsurance -- Discovery -- Deposition of corporate representative of medical provider is limited to accreditation/eligibility issue of declaratory action

26 Fla. L. Weekly Supp. 771b

Online Reference: FLWSUPP 2609JASMInsurance -- Discovery -- Depositions -- Insurer's corporate representative -- Scope of inquiry

26 Fla. L. Weekly Supp. 656b

Online Reference: FLWSUPP 2608HOLMInsurance -- Discovery -- Deposition duces tecum -- Corporate representative -- Relevant inquiries

26 Fla. L. Weekly Supp. 687a

Online Reference: FLWSUPP 2608PENNInsurance -- Discovery -- Depositions -- Plaintiff has right to take deposition of corporate representative who filed affidavit in support of summary judgment -- Plaintiff's motion to continue summary judgment hearing is granted, and insurer's motion for protective order regarding deposition is denied

26 Fla. L. Weekly Supp. 530a

Online Reference: FLWSUPP 2606MPORInsurance -- Personal injury protection -- Discovery -- Depositions -- Where case presents pure issues of law as to whether medical provider correctly coded services, provider's motion to compel deposition of insurer's corporate representative is denied and insurer's motion for protective order is granted

26 Fla. L. Weekly Supp. 529a

Online Reference: FLWSUPP 2606EPORInsurance -- Personal injury protection -- Discovery -- Depositions -- Where case presents pure issues of law as to whether medical provider correctly coded services, provider's motion to compel deposition of insurer's corporate representative is denied, and insurer's motion for protective order is granted

26 Fla. L. Weekly Supp. 528a

Online Reference: FLWSUPP 2606VASQInsurance -- Personal injury protection -- Discovery -- Depositions -- Objections -- Where insurer claims that it has paid PIP benefits by check sent with response to demand letter, insurer's objections to deposition questions asking deponent to identify persons who placed initials on response letter and wrote notation on letter indicating that check was sent under separate cover constitute bad faith conduct that warrants imposition of monetary sanction -- Insurer is ordered to answer questions previously subject to its objections

26 Fla. L. Weekly Supp. 861a

Online Reference: FLWSUPP 2610AGOLInsurance -- Personal injury protection -- Discovery -- Depositions -- Medical provider is prohibited from making inquiries during deposition of insurer's corporate representative that would require deponent to provide medical opinions, interpret law or policy, or testify as to claims-handling practices and procedures -- Provider is required to cooperate in scheduling hearing on motion for summary judgment

26 Fla. L. Weekly Supp. 847b

Online Reference: FLWSUPP 2610VIGOInsurance -- Discovery -- Depositions -- Corporate representative of insurer

26 Fla. L. Weekly Supp. 119a

Online Reference: FLWSUPP 2602EHRInsurance -- Personal injury protection -- Discovery -- Depositions -- Motion to compel deposition of insurer's corporate representative is granted -- Insurer is not permitted to depose medical provider's representative where, in view of documentation and records already in possession of insurer, deposition is not relevant and would not tend to lead to discovery of admissible evidence

26 Fla. L. Weekly Supp. 511a

Online Reference: FLWSUPP 2606BATIInsurance -- Personal injury protection -- Discovery -- Depositions -- Failure to appear -- Sanctions -- Attorney's fees and court reporting costs

26 Fla. L. Weekly Supp. 142a

Online Reference: FLWSUPP 2602MOISInsurance -- Discovery -- Depositions -- Failure to attend -- Sanctions -- Where, consistent with court procedures, medical provider unilaterally set deposition for claims representative with most knowledge after insurer failed to respond to three attempts to coordinate and schedule deposition, insurer never moved for protective order, and claims representative did not appear for deposition, provider is awarded attorney's fees, costs and monetary sanctions

26 Fla. L. Weekly Supp. 117a

Online Reference: FLWSUPP 2602ORIGInsurance -- Discovery -- Depositions -- Insurer's adjuster and corporate representative -- Sanction for failure to comply with prior order

26 Fla. L. Weekly Supp. 848d

Online Reference: FLWSUPP 2610EMJNInsurance -- Discovery -- Depositions -- Insured's treating physician is not entitled to expert witness fee for deposition testimony

26 Fla. L. Weekly Supp. 771a

Online Reference: FLWSUPP 2609FAIFInsurance -- Personal injury protection -- Discovery -- Depositions -- Treating physician is entitled to expert witness fee for deposition testimony -- Failure to appear -- Sanctions -- Medical provider is entitled to attorney's fees and court reporting costs where insurer's corporate representative failed to appear for deposition or file motion for protective order

26 Fla. L. Weekly Supp. 654a

Online Reference: FLWSUPP 2608NGINCivil procedure -- Expert witness -- Fees -- Treating physician is entitled to reasonable expert witness fee pursuant to rule 1.390 -- Fact that witness was treating physician does not render him a fact witness

26 Fla. L. Weekly Supp. 55a

Online Reference: FLWSUPP 2601ABERInsurance -- Personal injury protection -- Default -- Excusable neglect -- Due diligence -- Motion to vacate default final judgment is denied where affidavit filed in support of motion fails to set forth facts explaining or justifying the mistake or inadvertence that was responsible for 9-month delay between service of process and assignment of case and 5-month delay between entry of default judgment and assignment of case

26 Fla. L. Weekly Supp. 675a

Online Reference: FLWSUPP 2608DORInsurance -- Personal injury protection -- Discovery -- Failure to comply -- Sanctions -- Striking of insurer's pleadings is warranted as sanction for failing to respond to expert discovery and comply with court orders compelling responses where insurer's attorneys have been previously sanctioned, insurer was directly involved in disobedience, medical provider was prejudiced by delay, insurer was unable to articulate any sufficient justification for noncompliance, and delay created significant problems in judicial administration -- Default entered

26 Fla. L. Weekly Supp. 411a

Online Reference: FLWSUPP 2605PRESInsurance -- Personal injury protection -- Unpled issues -- Insurer's motion to strike issue not pled by medical provider is granted where sole issue raised by pleadings in PIP action was sufficiency of policy's notice of election of statutory fee schedules, and provider only raised issue regarding deductible after Florida Supreme Court ruled in favor of insurer on notice issue in another case

26 Fla. L. Weekly Supp. 657a

Online Reference: FLWSUPP 2608WOODInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Where there is no evidence that named insured elected deductible, claims should not have been subject to deductible -- Insurer was required to hold in reserve beyond 30 days that portion of emergency provider's claim that was disputed and remained unpaid at end of 30-day period -- Exhaustion of benefits is not defense to payment of disputed portion of emergency provider's claim

26 Fla. L. Weekly Supp. 510a

Online Reference: FLWSUPP 2606PORFInsurance -- Personal injury protection -- Coverage -- Deductible -- Insurer is required to apply deductible to 100% of insured's expenses and losses prior to applying permissive statutory fee schedule

26 Fla. L. Weekly Supp. 334a

Online Reference: FLWSUPP 2604GOODInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Deductible -- Insurer properly reduced medical provider's charges by application of statutory fee schedule before applying deductible

26 Fla. L. Weekly Supp. 124a

Online Reference: FLWSUPP 2602FREMInsurance -- Personal injury protection -- Deductible -- Statute requires that deductible be applied to 100 percent of reasonable expenses -- Insurer properly applied deductible to amount calculated pursuant to statutory fee schedules, rather than to total amount billed by provider -- Question certified: Pursuant to sections 627.736 and 627.739, Florida Statutes (2010), is an insurer required to apply a policy deductible to the total amount of a provider's invoices to an insurer prior to applying any fee schedule found in § 627.736?

26 Fla. L. Weekly Supp. 611a

Online Reference: FLWSUPP 2608RIVEInsurance -- Personal injury protection -- Benefits -- Deductible -- Section 627.739(2) requires that deductible be applied to 100% of expenses and losses before reducing amount paid pursuant to statutory reimbursement limitation

26 Fla. L. Weekly Supp. 666a

Online Reference: FLWSUPP 2608PEREInsurance -- Personal injury protection -- Deductible applies to bill for injuries sustained by dependent relative of named insured -- Because bill at issue was the first compensable bill received by insurer, deductible applied to entire amount claimed

26 Fla. L. Weekly Supp. 589a

Online Reference: FLWSUPP 2607FERNInsurance -- Property -- Water remediation service that is assignee of insureds can maintain action for declaratory relief seeking declaration of coverage

26 Fla. L. Weekly Supp. 139a

Online Reference: FLWSUPP 2602PRADInsurance -- Personal injury protection -- Declaratory action -- Motion for reconsideration of order denying motion to dismiss count of complaint that seeks declaratory relief regarding unpaid portion of PIP claims is denied where challenged order was agreed to between parties, and insurer has failed to show that order was entered based on error, coercion or injustice -- Moreover, fact that medical provider has another remedy at law does not preclude judgment for declaratory relief

26 Fla. L. Weekly Supp. 233a

Online Reference: FLWSUPP 2603BHANInsurance -- Personal injury protection -- Insurer's motion for final summary judgment on ground that policy PIP benefits have been exhausted is denied where plaintiff is not seeking PIP benefits, but a declaratory judgment on the issue of whether policy clearly and unambiguously elected schedule of maximum charges payment calculation method, in which case provider would be prohibited from balance billing the insured for amounts not paid by insurer, or whether fact-dependent payment calculation method described in section 627.736(5)(a) applied -- Regardless of whether benefits are exhausted, bona fide, actual, and present practical need for declaration exists

26 Fla. L. Weekly Supp. 896c

Online Reference: FLWSUPP 2611RAMIInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Standing -- Insured who has assigned PIP benefits to medical providers lacks standing to bring action for declaratory judgment regarding coverage

26 Fla. L. Weekly Supp. 481a

Online Reference: FLWSUPP 2606WADEInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Declaratory actions -- Standing -- Insured had standing to seek declaratory relief where insurer was in doubt as to amount of coverage insured was entitled to based on dispute as to whether he suffered emergency medical condition -- Trial court did not err in entering summary judgment determining that insured suffered emergency medical condition -- However, trial court erred in awarding insured remainder of PIP benefits where insured did not satisfy pre-suit demand letter requirements

26 Fla. L. Weekly Supp. 33a

Online Reference: FLWSUPP 2601ZAMOInsurance -- Personal injury protection -- Coverage -- Declaratory judgments -- Court has jurisdiction to consider count in which provider seeks a declaration regarding whether policy at issue is clear and unambiguous and to insurer's chosen methodology of reimbursement

26 Fla. L. Weekly Supp. 347a

Online Reference: FLWSUPP 2605WADEInsurance -- Personal injury protection -- Declaratory action -- Coverage -- Emergency medical condition -- Where parties disputed whether insured had suffered emergency medical condition that would entitle him to receive more PIP benefits, insured had standing to seek declaratory relief -- Trial court erred in awarding insured remainder of available PIP benefits where insured did not satisfy presuit demand letter requirements

26 Fla. L. Weekly Supp. 40a

Online Reference: FLWSUPP 2601GILInsurance -- Personal injury protection -- Charge for electrodes pursuant to CPT code A4556 is covered under PIP statute

26 Fla. L. Weekly Supp. 414a

Online Reference: FLWSUPP 2605FREYInsurance -- Where medical provider's attorney filed amended petition for declaratory relief only minutes before hearing on motion to dismiss original petition, and facts indicate that primary purpose of filing amended petition was to cause unreasonable delay, insurer's motion for sanctions is granted

26 Fla. L. Weekly Supp. 536a

Online Reference: FLWSUPP 2607TORRInsurance -- Personal injury protection -- Counsel -- Disqualification -- Prior representation of opposing party -- Abuse of discretion to deny insurer's motion to disqualify law firm as medical provider's counsel in 215 pending PIP cases based on fact that attorney who is now employed by provider's law firm was previously employed by law firm that represents insurer where attorney possessed considerable confidential information regarding insurer's defense of PIP claims in general, and defense of claims regarding whether insurer's policy provides sufficient notice of election to use statutory fee schedules in particular, and fact that attorney's representation of provider would require her to take opposite position regarding interpretation of insurer's policy than position that she had represented to various courts as being legally correct when she was representing insurer demonstrates that current cases and cases in which attorney represented insurer are substantially related matters -- Trial court departed from essential requirements of law by holding that insurer must prove that disclosure and use of confidential information resulted in unfair advantage to provider as predicate to disqualification and by placing reliance on statements that attorney's new firm would screen attorney from cases in which insurer is defendant -- Provider's law firm remains disqualified despite fact that it no longer employs attorney

26 Fla. L. Weekly Supp. 30a

Online Reference: FLWSUPP 2601WADEInsurance -- Complaint -- Amendment -- Motion to amend complaint by interlineation to correct name of defendant insurer is granted where named defendant and correct insurer are sufficiently related, and plaintiff moved to amend in timely manner so as to cause no prejudice

26 Fla. L. Weekly Supp. 752a

Online Reference: FLWSUPP 2609FELIInsurance -- Complaint -- Amendment -- More definite statement required

26 Fla. L. Weekly Supp. 771c

Online Reference: FLWSUPP 2609BRANInsurance -- Personal injury protection -- Motion to strike or exclude unpled or waived issues is granted -- Bar to injection of new claim or theory subsequent to a recent Florida Supreme court ruling that undermined the original claim or theory

26 Fla. L. Weekly Supp. 231a

Online Reference: FLWSUPP 2603DELCInsurance -- Personal injury protection -- Complaint -- Amendment -- Medical provider's motion to amend complaint to add count for declaratory judgment on issue of alleged misapplication of deductible is denied where primary issue framed for disposition by pleadings during almost five years of litigation was whether PIP policy provided sufficient notice of election of statutory fee schedules, provider did not move to amend complaint until after Florida Supreme Court decided election issue in favor of insurer in another case, and allowing amendment would unfairly prejudice insurer that has forfeited numerous defenses on assumption that election issue was primary issue in case

26 Fla. L. Weekly Supp. 745b

Online Reference: FLWSUPP 2609LOWRInsurance -- Personal injury protection -- Class action concerning amendments to PIP statute requiring claimant to receive initial services and care within 14 days of accident -- Standing -- Issue of standing must be determined before addressing whether case is properly maintainable as class action -- Medical provider lacked third-party standing at inception of lawsuit -- Fact that insured had assigned PIP benefits to provider did not hinder insured from asserting her own rights, as demonstrated by fact that insured subsequently obtained reassignment of benefits from provider and was added as party -- Insured's addition as party plaintiff cannot cure standing defect where provider lacked standing at inception of case -- Motion for class certification is denied and action is dismissed for lack of standing

26 Fla. L. Weekly Supp. 886a

Online Reference: FLWSUPP 2611SMITClass actions -- Certification -- Insurance -- Homeowners -- Coverage -- Limitation of liability -- Reasonable emergency services -- Motion for class certification denied in action alleging insurer breached its contract with insured by improperly limiting reimbursement for repair/remediation costs pursuant to policy's cap on Reasonable Emergency Measures although policy contained all risk coverage with no exclusions or limitations -- Class certification is inappropriate where plaintiff seeks monetary damages, not declaratory or injunctive relief; there is no claim that a limited fund exists; and determining whether an insured met class definition would require a file-by-file analysis, an administratively unfeasible method of class determination

26 Fla. L. Weekly Supp. 876a

Online Reference: FLWSUPP 2611DICKInsurance -- Automobile -- Windshield repair -- Policy provision limiting insurer's liability for windshield repair to prevailing competitive price and providing that this is price insurer can secure from competent and conveniently located repair facility is not ambiguous and requires insurer to pay price of repair it can secure in competitive market from competent and conveniently located repair facility -- Where trial court records are insufficient to evaluate whether prices proposed by parties met prevailing competitive price standard, judgments are vacated and cases are remanded for additional proceedings

26 Fla. L. Weekly Supp. 777a

Online Reference: FLWSUPP 2609DELAInsurance -- Automobile -- Windshield repair -- Discovery -- Relevance -- Where primary issue in repair shop's action against insurer involves meaning of term “prevailing competitive price” in limitation of liability clause of policy, information regarding vendor that has been used by insurer to administer claims, compile payment data for windshield claims, and provide records on which insurer relies as prevailing competitive prices is reasonably calculated to lead to discovery of admissible evidence -- Privilege -- Insurer is required to produce privilege log corresponding to privilege-based objections -- If documents are found to be trade secrets after in camera inspection, parties will be required to jointly prepare confidentiality order

26 Fla. L. Weekly Supp. 780a

Online Reference: FLWSUPP 2609RIVEInsurance -- Automobile -- Windshield repair -- Term “prevailing competitive price” used in limit of liability clause in automobile insurance policy and described as “price we can secure from competent and conveniently located repair facility” is intrinsically ambiguous -- Even if policy is not ambiguous, insurer cannot meet burden to show that invoiced amount for windshield repair is not prevailing competitive price by arguing that prevailing competitive price is limited to amount it alone could obtain from “in-network” shops with whom it has pricing agreement; insurer must demonstrate price it can secure in competitive market -- Where insurer has paid amount of plaintiff's invoice without reduction on multiple occasions, insurer itself has determined that invoiced amount does not exceed prevailing competitive price -- Fact that plaintiff may have charged lower price to uninsured customers in isolated instances does not mean charge at issue is not prevailing competitive price

26 Fla. L. Weekly Supp. 976a

Online Reference: FLWSUPP 2612ARIKInsurance -- Automobile -- Windshield repair or replacement -- Discovery -- Depositions -- Trade secrets -- Insurer's corporate representative is ordered to answer questions relating to methodology used by insurer to determine “price we can secure” and “prevailing competitive price” -- Court will conduct in camera inspection of documents claimed to constitute trade secret

26 Fla. L. Weekly Supp. 779a

Online Reference: FLWSUPP 2609RICCInsurance -- Automobile -- Windshield repair -- Partial summary judgment is entered in favor of plaintiff on issue of whether plaintiff is competent and conveniently located repair facility within meaning of policy's limit of liability clause

26 Fla. L. Weekly Supp. 165b

Online Reference: FLWSUPP 2603WALSInsurance -- Automobile -- Coverage -- Trial court did not err in granting insurer's motion for summary judgment in action brought by assignee/repair facility seeking payment in excess of the amount stated in written estimate obtained by insurer where policy had provision requiring approval for any estimates submitted by insured or third party and provided the insured an opportunity to contact the insurer if insured could not find a repair shop that would perform the repair work for the amount stated in insurer's estimate

26 Fla. L. Weekly Supp. 141a

Online Reference: FLWSUPP 2602SMIKInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Insurer's renewed motion for entitlement to attorney's fees and to tax costs granted -- Facts and circumstances surrounding insurer's nominal offer demonstrate that, at time offer was made, insurer had reasonable basis to conclude that its exposure was nominal

26 Fla. L. Weekly Supp. 588b

Online Reference: FLWSUPP 2607JFERInsurance -- Declaratory actions -- Attorney's fees -- Proposal for settlement statute is not applicable to actions seeking non-monetary relief -- Proposal is stricken

26 Fla. L. Weekly Supp. 589b

Online Reference: FLWSUPP 2607BRUCInsurance -- Attorney's fees -- Proposal for settlement -- Although medical provider's complaint sought both equitable relief and non-equitable relief, where true relief sought was money damages, proposal for settlement statute is applicable

26 Fla. L. Weekly Supp. 744a

Online Reference: FLWSUPP 2609MILLInsurance -- Uninsured motorist -- Bad faith claim -- Attorney's fees -- Insured who was subject to jury award exceeding policy limits on claim for UM benefits and thereafter settled claim for bad faith against insurer is not entitled to attorney's fees for time spent in furtherance of underlying action for UM benefits -- Insured is not entitled to recover attorney's fees for time spent litigating amount of fees to be awarded

26 Fla. L. Weekly Supp. 982a

Online Reference: FLWSUPP 2612COR2Insurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Good faith offer -- Minimal offer was made in good faith where insurer had reasonable belief that its liability for benefits to insured who failed to appear at two examinations under oath would be nominal -- Insurer is entitled to award of attorney's fees and costs

26 Fla. L. Weekly Supp. 414b

Online Reference: FLWSUPP 2605TUNCInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Nominal offer for settlement was made in good faith where insurer had reasonable basis to conclude that its exposure was nominal in suit challenging whether policy language allowed insurer to limit reimbursement pursuant to statutory fee schedules

26 Fla. L. Weekly Supp. 229a

Online Reference: FLWSUPP 2603HOLLInsurance -- Personal injury protection -- Attorney's fees -- Where insurer confessed judgment as to medical provider's entitlement to penalty and postage, provider is entitled to award of attorney's fees under section 627.428 -- Even under case law holding that to be entitled to award of fees under section 627.428 a party must obtain PIP benefits that are provided for in PIP policy, provider is entitled to award of fees where PIP policy at issue makes payment of penalty a PIP benefit

26 Fla. L. Weekly Supp. 321a

Online Reference: FLWSUPP 2604WOODInsurance -- Personal injury protection -- Attorney's fees -- Confession of judgment -- Insurer's post-suit payment of benefits effected a confession of judgment entitling medical provider to attorney's fees and costs irrespective of whether insurer had notice of suit prior to paying disputed benefits -- Provider is also entitled to fees for time spent litigating entitlement to fees

26 Fla. L. Weekly Supp. 240a

Online Reference: FLWSUPP 2603CARRInsurance -- Personal injury protection -- Attorney's fees -- Confession of judgment -- Where insurer made payment to provider after lawsuit was filed, a proper demand letter having been served, provider is entitled to attorney's fees and costs as a prevailing party even if the payment subsequently made exhausted policy benefits

26 Fla. L. Weekly Supp. 514a

Online Reference: FLWSUPP 2606MAYLInsurance -- Automobile -- Windshield repair -- Small claims -- Attorney's fees -- Offer of judgment -- Prevailing insurer is entitled to recover attorney's fees incurred from date offer of judgment was served on windshield repair service

26 Fla. L. Weekly Supp. 989a

Online Reference: FLWSUPP 2612DINGInsurance -- Personal injury protection -- Attorney's fees -- Proposal for settlement -- Because mandatory email service requirement in rule 2.516(b)(1) is not applicable to pretrial proposal for settlement, fact that proposal does not indicate service on secondary email address of medical provider's attorney does not render proposal invalid -- Where there is typographical error in email address listed in proposal's certificate of service, insurer is not entitled to presumption of valid service of proposal -- However, where evidence from insurer's email archiver indicates that proposal was sent to proper email address, court finds that provider received notice of proposal -- Insurer is not required to prove that proposal was received by provider, only that it was served -- Despite typographical errors in email addresses listed in certificates of service on motions for attorney's fees and notice of filing proposal for settlement, where e-filing portal reflects service on proper email addresses, insurer complied with service requirements -- Rule 1.442 did not require insurer to attach proposal for settlement to motion for attorney's fees or otherwise file proposal within 30 days after filing of judgment -- Ambiguity -- Fact that proposal does not track language of rule 1.442 by including phrase “all damages that would otherwise be awarded in final judgment in the action” does not render proposal invalid or ambiguous -- Language in proposal seeking to resolve “any and all claims which plaintiff...has or could have asserted in this action” is not overbroad or ambiguous -- Nominal proposal was made in good faith

26 Fla. L. Weekly Supp. 832a

Online Reference: FLWSUPP 2610THOMAttorney's fees -- Justiciable issues -- Claim or defense not supported by material facts or applicable law -- Insurance -- Personal injury protection insurer's motion for sanctions pursuant to section 57.105, alleging that provider's presuit demand letter was deficient because it failed to provide insurer with exact amount at issue, lacked any basis in fact or law -- Insurer knew, or should have known, that demand letter arguably complied with statute based on same or similar challenges raised in prior motions for summary judgment in sister courts -- Insurer's motion for sanctions denied -- Provider's motion for sanctions granted

26 Fla. L. Weekly Supp. 512c

Online Reference: FLWSUPP 2606DORTInsurance -- Personal injury protection -- Attorney's fees -- Claim or defense not supported by material facts or applicable law -- Where medical provider knew or should have known before filing suit that its demand letter was invalid for failing to include itemized statement of charges and assignment of benefits, insurer's motion for section 57.105 sanctions is granted -- Further, motion for sanctions for provider's failure to comply with discovery order is granted -- Provider's concession that insurer is entitled to reasonable attorney's fees and costs did not render motions for sanctions moot

26 Fla. L. Weekly Supp. 32b

Online Reference: FLWSUPP 2601NZAMInsurance -- Personal injury protection -- Attorney's fees -- Claim or defense not supported by material facts or applicable law -- Medical provider is entitled to award of attorney's fees for defending against affirmative defense alleging that statute of limitations on provider's claim had expired where provider filed suit within five-year limitations period following expiration of thirty days after insurer was furnished notice of covered loss

26 Fla. L. Weekly Supp. 594b

Online Reference: FLWSUPP 2607MCDONOT FINAL VERSION OF OPINION
Subsequent Changes at 27 Fla. L. Weekly Supp. 744aInsurance -- Personal injury protection -- Voluntary dismissal -- Timeliness -- Medical provider's notice for voluntary dismissal entered at hearing after court denied motion for continuance but before beginning of argument on insurer's motion for summary judgment was timely entered prior to hearing on motion for summary judgment -- Attorney's fees -- Timely voluntary dismissal deprived court of jurisdiction to adjudicate motion for summary judgment based on defective demand letter but did not deprive it of jurisdiction to entertain motion for section 57.105 sanctions -- Where amount owed alleged in demand letter was far in excess of coverage available under policy and differed from attached ledger and jurisdictional amount pled in complaint, provider's counsel knew or should have known that letter did not satisfy condition precedent to filing suit, and insurer is entitled to award of attorney's fees

26 Fla. L. Weekly Supp. 973a

Online Reference: FLWSUPP 2612THOMInsurance -- Attorney's fees -- Justiciable issues -- Plaintiff and its counsel are liable in equal parts for defendant's attorney's fees pursuant section 57.105(1) where plaintiff and counsel knew before filing breach of contract claim that patient did not have a policy of insurance with defendant -- Plaintiff or its counsel could have and should have verified coverage through patient prior to filing lawsuit -- Argument that plaintiff had an additional 5 days to dismiss action pursuant to rule 2.514(b) because motion for sanctions was served by email is without merit -- The additional 5 days set forth in rule 2.514(b) is not applicable to the 21-day safe harbor provision of section 57.105(4), as this safe harbor provision is a compliance statute for the party seeking sanctions and does not require or suggest any action on the part of the offending party

26 Fla. L. Weekly Supp. 755a

Online Reference: FLWSUPP 2609HOLLInsurance -- Personal injury protection -- Attorney's fees -- Amount -- Contingency risk multiplier -- Multiplier is not warranted where there is no showing that medical provider had difficulty finding attorney or that market required multiplier to obtain competent counsel, attorneys did not give up any work to handle matter, and record reflects long periods in which attorneys performed no work on case -- Amount of hours claimed is unreasonable for small claims PIP case

26 Fla. L. Weekly Supp. 599a

Online Reference: FLWSUPP 2607SLOSInsurance -- Personal injury protection -- Attorney's fees -- Discovery -- Insurer's motion for protective order barring medical provider from deposing insurer's corporate representative is granted where sole remaining issue is amount of fees owed to insurer, insurer has responded to all of provider's other discovery requests, and provider has not demonstrated any reason for deposition -- Provider's request for unredacted attorney timesheets is denied where insurer is not seeking payment for redacted time entries -- Provider is not entitled to discovery of insurer's communications, invoices, and payments to counsel in other PIP cases or proposals for settlement served by insurer in other PIP cases -- Motion to compel mediation is granted

26 Fla. L. Weekly Supp. 670b

Online Reference: FLWSUPP 2608REYEAttorney's fees -- Insurance -- Contingency risk multiplier of 2.0 awarded -- Expert witness fees -- Taxable costs

26 Fla. L. Weekly Supp. 637a

Online Reference: FLWSUPP 2608ZUNIInsurance -- Homeowners -- Water intrusion -- Attorney's fees -- Contingency multiplier -- Multiplier permitted in award of fees where liability in case was certain to be contested and evidence showed relevant market required the prospect of multiplier to secure competent counsel -- Court's findings that client was unable to pay hourly fees and could proceed only on pure contingency fee basis also support application of multiplier -- Where, from the vantage point of counsel, prospect of recovery was “more likely than not” the court has discretion to award a multiplier of 1 to 1.5

26 Fla. L. Weekly Supp. 256a

Online Reference: FLWSUPP 2604GARCInsurance -- Personal injury protection -- Attorney's fees -- Appellate -- Prevailing party -- Confession of judgment

26 Fla. L. Weekly Supp. 545b

Online Reference: FLWSUPP 2607WOODInsurance -- Personal injury protection -- Evidence -- No error in excluding insurer's expert or in admitting medical provider as expert -- Attorney's fees -- Prevailing party

26 Fla. L. Weekly Supp. 589c

Online Reference: FLWSUPP 2607ASTOInsurance -- Personal injury protection -- Attorney's fees -- Amount -- Contingency risk multiplier -- Where evidence indicates that medical provider had no difficulty in obtaining competent counsel and does not support contention that relevant market requires contingency risk multiplier in order to obtain competent counsel, competent substantial evidence does not support award of multiplier

26 Fla. L. Weekly Supp. 848b

Online Reference: FLWSUPP 2610AKINInsurance -- Attorney's fees -- Amount

26 Fla. L. Weekly Supp. 838b

Online Reference: FLWSUPP 2610DOMEInsurance -- Attorney's fees -- Amount

26 Fla. L. Weekly Supp. 692b

Online Reference: FLWSUPP 2608MOZAInsurance -- Attorney's fees -- Amount

26 Fla. L. Weekly Supp. 661b

Online Reference: FLWSUPP 2608FUENInsurance -- Attorney's fees -- Amount

26 Fla. L. Weekly Supp. 661a

Online Reference: FLWSUPP 2608AVERInsurance -- Attorney's fees -- Amount

26 Fla. L. Weekly Supp. 41b

Online Reference: FLWSUPP 2601SANTInsurance -- Attorney's fees -- Amount -- Contingency risk multiplier of 1.50 is awarded to medical provider

26 Fla. L. Weekly Supp. 41a

Online Reference: FLWSUPP 2601GREEInsurance -- Attorney's fees -- Amount

26 Fla. L. Weekly Supp. 24a

Online Reference: FLWSUPP 2601BURKInsurance -- Attorney's fees -- Amount -- Reasonable hourly rate

26 Fla. L. Weekly Supp. 501a

Online Reference: FLWSUPP 2606ROJEInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Insurer improperly processed bill of emergency medical provider by applying deductible to bills out of order of receipt -- Standing -- Assignment of benefits to “Facility and/or the Provider” confers standing on emergency room physicians -- Insurer cannot dispute reasonableness of charge after it allows full amount of charge pursuant to statutory fee schedule when applying charge to deductible

26 Fla. L. Weekly Supp. 504a

Online Reference: FLWSUPP 2606MIRAInsurance -- Personal injury protection -- Coverage -- Emergency services -- Deductible -- Insurer improperly processed provider's medical bills by applying PIP deductible to the bills out of order of receipt -- Standing -- Language of assignment was sufficient to convey standing to plaintiff to pursue payment for treatment rendered to insured -- Moreover, issue was waived where insurer's corporate representative testified that insurer was not disputing plaintiff's standing -- Exhaustion of benefits -- Statute and language of policy at issue required insurer to reserve $5000 for protected providers such as plaintiff, and any payments made to non-protected providers from the reserve fund during the thirty-day reserve period are considered gratuitous -- Reasonable, related, and necessary treatment -- Deposition of insurer's corporate representative confirmed that insurer was not disputing relatedness and necessity of services provided to insured -- Insurer deemed plaintiff's charges to be reasonable as evidenced by fact that it allowed plaintiff's bill at 100% of the charged amount pursuant to schedule of maximum charges, and insurer admitted that it determined plaintiff's charge to be reasonable in its answer to plaintiff's request for admissions -- Summary judgment granted in favor of plaintiff

26 Fla. L. Weekly Supp. 619a

Online Reference: FLWSUPP 2608JRIVInsurance -- Personal injury protection -- Standing -- Validity of assignment -- There is no distinction between a direction to pay and an assignment of benefits for purposes of standing, and language indicating that an insured is assigning “any and all causes of action” is not required -- Error to dismiss for lack of standing due to insured's apparent mistake of assigning benefits to himself on contract with provider -- Insured's mistake, at most, creates an ambiguous assignment and a court may not engage in contractual interpretation at the motion to dismiss stage

26 Fla. L. Weekly Supp. 147a

Online Reference: FLWSUPP 2602COMMInsurance -- Personal injury protection -- Standing -- Assignment -- Validity -- Document assigning right to receive payment of PIP benefits also bestows on medical provider right to enforce any claims to those benefits -- Insurer's motion for summary judgment in regards to standing is denied

26 Fla. L. Weekly Supp. 516a

Online Reference: FLWSUPP 2606VIENInsurance -- Personal injury protection -- Coverage -- Medical expenses -- Independent medical examinations -- Failure to attend -- Where medical provider has filed no evidence to rebut presumption that insured's failure to attend two IMEs was unreasonable, insurer is no longer liable for subsequent PIP benefits -- No merit to argument that insured was not required to submit to chiropractic IME where treatment was provided by medical doctors -- Standing -- “Irrevocable Medical Lien” is not assignment of benefits -- Purported assignment furnished at summary judgment hearing is not considered where document was not timely provided to insurer's counsel -- Where insured unreasonably failed to submit to IMEs, provider's bills were not overdue, demand letter was premature and invalid, and provider failed to satisfy condition precedent to suit

26 Fla. L. Weekly Supp. 333a

Online Reference: FLWSUPP 2604PATHNOT FINAL VERSION OF OPINION
Subsequent Changes at 26 Fla. L. Weekly Supp. 521bInsurance -- Personal injury protection -- Standing -- Assignment -- Motion for judgment on pleadings based on medical provider's lack of standing under assignment that is in name of entity that merged into provider after execution of assignment is granted where allegations about merger are not included in complaint and provider failed to move to amend complaint to include such allegations -- No merit to argument that difference in name of assignee is latent ambiguity in assignment that would allow court to consider extrinsic evidence to interpret it -- Matters outside pleadings cannot be considered in ruling on motion for judgment on pleadings, and there is no ambiguity in identification of parties to assignment

26 Fla. L. Weekly Supp. 893a

Online Reference: FLWSUPP 2611TAYLInsurance -- Personal injury protection -- Standing -- Assignment -- Where plaintiff has management services agreement allowing it to pursue claims on behalf of medical provider that is insured's assignee, and bills submitted by plaintiff to insurer throughout insured's course of treatment have been paid by insurer, plaintiff has standing to bring suit for unpaid PIP benefits

26 Fla. L. Weekly Supp. 363a

Online Reference: FLWSUPP 2605CARVInsurance -- Homeowners -- Standing -- Assignment -- No merit to argument that assignment that was executed by only one of two insured homeowners is only partial assignment that does not confer standing on contractor/assignee -- Questions of whether husband who did not sign assignment is indispensable party and whether his wife could waive his rights under insurance policy require determinations of fact that cannot be resolved within four corners of complaint -- Motion to dismiss denied

26 Fla. L. Weekly Supp. 972a

Online Reference: FLWSUPP 2612TESTInsurance -- Homeowners -- Standing -- Assignment to unregistered fictitious name -- Plaintiff's failure to register fictitious name does not render assignment invalid -- Lack of initial standing due to unregistered fictitious name can be cured without dismissing and refiling case

26 Fla. L. Weekly Supp. 350d

Online Reference: FLWSUPP 2605ALLSInsurance -- Homeowners -- Standing -- Assignment -- Validity -- Trial court improperly granted summary judgment in favor of insurer based on erroneous finding that homeowner's authorization for fiancé to sign assignment of benefits to plaintiff hired to repair damage to home was required by statute of frauds to be in writing -- Assignment does not relate to real property; it relates to insurance claim, which is chose in action to which statute of frauds is not applicable

26 Fla. L. Weekly Supp. 628a

Online Reference: FLWSUPP 2608LANGInsurance -- Homeowners -- Assignment -- Insurer did not have standing to challenge consideration with respect to assignment between plaintiff and insureds -- Genuine issue of fact exists as to whether wife acquiesced to assignment of benefits signed by husband

26 Fla. L. Weekly Supp. 495a

Online Reference: FLWSUPP 2606DOKTInsurance -- Homeowners -- Standing -- Assignment -- Public adjuster -- Insurer has no standing to challenge assignment through which insureds assigned post-loss insurance benefits to public adjuster -- Statute which prohibits public adjuster from charging or accepting more than 20% of claim payments made by insurer deals solely with compensation of public adjuster for services rendered as public adjuster and did not preclude insureds from assigning post-loss benefits to public adjuster after public adjusting work ended -- Moreover, assignment that provides that public adjuster will only receive 20% of any recovery for insurer did not violate public adjusting law if that law is applicable

26 Fla. L. Weekly Supp. 118c

Online Reference: FLWSUPP 2602KOLLInsurance -- Insurer's obligation to pay insured's assignee was not discharged by issuing a check to insured-assignor that was jointly payable to the assignor and the assignee

26 Fla. L. Weekly Supp. 681a

Online Reference: FLWSUPP 2608EDWAInsurance -- Automobile -- Windshield replacement -- Limitation of liability -- Where insurer did not present any evidence of prices that are prevailing and competitive or of method for calculating what windshield replacement service would cost in competitive market at time of loss, insurer failed to prove that its liability is limited under policy clause limiting liability to prevailing competitive price to repair or replace property at time of loss -- Standing -- Assignment -- No merit to argument that assignment of benefits to repair shop was insufficient -- Equitable estoppel -- Argument that repair shop was equitably estopped from recovering more than prevailing competitive price where it performed work despite being aware from course of dealings with insurer that insurer would not pay more than prevailing competitive price fails where insurer did not present evidence that repair shop represented that it accepted insurer's pricing limits, that insurer relied on any such representation or that insurer changed its position in detrimental reliance on any such representation -- Waiver -- No merit to argument that repair shop waived right to seek additional benefits by performing work after receiving document that stated insurer's pricing limits and that performance of services constituted acceptance of price where insurer offered no evidence that repair shop intended to relinquish right to charge what it deemed necessary to replace windshield -- Instead, evidence showed that shop immediately notified insurer through its invoice that it did not accept insurer's pricing limits and has constantly reminded insurer of its intention not to accept those limits through series of lawsuits -- Repair shop's motion for directed verdict is granted

26 Fla. L. Weekly Supp. 423a

Online Reference: FLWSUPP 2605CLARInsurance -- Homeowners -- Water damage -- Arbitration -- Absence of timely request for trial de novo -- Judgment entered in accordance with arbitration award finding in favor of assignee who performed water remediation services following one-time water event caused by broken supply line beneath kitchen sink

26 Fla. L. Weekly Supp. 829a

Online Reference: FLWSUPP 2610PARRInsurance -- Property -- Appraisal -- Impartial appraiser -- Where insured disclosed to insurer that he had agreement with his designated appraiser to serve as public adjuster on claim, insurance policy's appraisal provision requiring parties to select disinterested appraiser is satisfied and disqualification of appraiser is not appropriate